Provider Demographics
NPI:1710555891
Name:CHARLES, PORTER (LICSW)
Entity Type:Individual
Prefix:
First Name:PORTER
Middle Name:
Last Name:CHARLES
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 ALEWIFE BROOK PKWY # 1064
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-1102
Mailing Address - Country:US
Mailing Address - Phone:508-263-0864
Mailing Address - Fax:
Practice Address - Street 1:160 ALEWIFE BROOK PKWY # 1064
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-1102
Practice Address - Country:US
Practice Address - Phone:508-263-0864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-15
Last Update Date:2024-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical