Provider Demographics
NPI:1710078068
Name:CHARMAK, WILLIAM D (PHD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:D
Last Name:CHARMAK
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:PO BOX 3677
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03061-3677
Mailing Address - Country:US
Mailing Address - Phone:603-577-7900
Mailing Address - Fax:603-577-7972
Practice Address - Street 1:19 TYLER ST STE 103
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060-2951
Practice Address - Country:US
Practice Address - Phone:603-577-5375
Practice Address - Fax:603-577-5609
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03296103TB0200X, 103TC0700X, 103TC1900X
NH1533103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD152136OtherVALUE OPTIONS
MD5339652OtherAETNA
MD36140013OtherCAREFIRST DC
MD3162004OtherUBH/ONE NET/MAMSI
MD54622502OtherCAREFIRST BCBS
MD5339652OtherAETNA
MD521885475OtherTAX ID NUMBER