Provider Demographics
NPI:1821313792
Name:SOLDEVILLA, CHARLES ARTHUR
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:ARTHUR
Last Name:SOLDEVILLA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:172 SUMNER ST W
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-1046
Mailing Address - Country:US
Mailing Address - Phone:508-427-6519
Mailing Address - Fax:
Practice Address - Street 1:172 SUMNER ST W
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-1046
Practice Address - Country:US
Practice Address - Phone:508-427-6519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-02
Last Update Date:2010-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health