Provider Demographics
NPI:1881690014
Name:MARTEL, CHARLES G (LICSW)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:G
Last Name:MARTEL
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 1:20 PARK PLZ
Mailing Address - Street 2:STE 604
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-4319
Mailing Address - Country:US
Mailing Address - Phone:617-350-7800
Mailing Address - Fax:
Practice Address - Street 1:20 PARK PLZ
Practice Address - Street 2:STE 604
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-4319
Practice Address - Country:US
Practice Address - Phone:617-350-7800
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1032751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPO1383Medicare ID - Type Unspecified