Provider Demographics
NPI:1912005588
Name:CHARRON, MABEL (PMHNP BC)
Entity Type:Individual
Prefix:
First Name:MABEL
Middle Name:
Last Name:CHARRON
Suffix:
Gender:F
Credentials:PMHNP BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 51533
Mailing Address - Street 2:
Mailing Address - City:INDIAN ORCHARD
Mailing Address - State:MA
Mailing Address - Zip Code:01151-5533
Mailing Address - Country:US
Mailing Address - Phone:413-775-3355
Mailing Address - Fax:413-858-7645
Practice Address - Street 1:733 CHAPIN ST STE 200
Practice Address - Street 2:
Practice Address - City:LUDLOW
Practice Address - State:MA
Practice Address - Zip Code:01056-1900
Practice Address - Country:US
Practice Address - Phone:413-775-3355
Practice Address - Fax:413-858-7645
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2019-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA214158364SP0807X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No364SP0807XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1303295Medicaid