Provider Demographics
NPI:1679065148
Name:VERGE, CHARLES G (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:G
Last Name:VERGE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1175 CHESTNUT ST APT 4
Mailing Address - Street 2:
Mailing Address - City:NEWTON UPPER FALLS
Mailing Address - State:MA
Mailing Address - Zip Code:02464-1336
Mailing Address - Country:US
Mailing Address - Phone:161-796-6273
Mailing Address - Fax:
Practice Address - Street 1:11 RIVER ST
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-2098
Practice Address - Country:US
Practice Address - Phone:781-239-1772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-31
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2020103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical