Provider Demographics
NPI:1790878239
Name:TAYLOR, CHARLES WESLEY (LICSW)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:WESLEY
Last Name:TAYLOR
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 1:62 FRANKLIN RD.
Mailing Address - Street 2:
Mailing Address - City:NORWELL
Mailing Address - State:MA
Mailing Address - Zip Code:02061-1538
Mailing Address - Country:US
Mailing Address - Phone:781-878-8120
Mailing Address - Fax:
Practice Address - Street 1:62 FRANKLLIN RD.
Practice Address - Street 2:
Practice Address - City:NORWELL
Practice Address - State:MA
Practice Address - Zip Code:02061-1538
Practice Address - Country:US
Practice Address - Phone:781-878-8120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1005561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical