Provider Demographics
NPI:1851565410
Name:BUDRIUS, CHARLENE A I (CNS)
Entity Type:Individual
Prefix:
First Name:CHARLENE
Middle Name:A
Last Name:BUDRIUS
Suffix:I
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 ADDISON ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02476-8107
Mailing Address - Country:US
Mailing Address - Phone:781-643-4530
Mailing Address - Fax:
Practice Address - Street 1:169 ELM ST
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02453-5356
Practice Address - Country:US
Practice Address - Phone:781-894-8440
Practice Address - Fax:781-894-1202
Is Sole Proprietor?:No
Enumeration Date:2008-04-15
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA115701364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1303287Medicaid
MA703136OtherTUFTS
MA0023532OtherBMC
MA1303287OtherMBHP
MAH1004745OtherNHP
MA99618201OtherNETWORK HEALTH
MACP0110OtherBCBS