Provider Demographics
NPI:1023230372
Name:BILLIKAS, CHARLES NICHOLAS (PSYD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:NICHOLAS
Last Name:BILLIKAS
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 BROOK STREET
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:MA
Mailing Address - Zip Code:02038
Mailing Address - Country:US
Mailing Address - Phone:508-498-0766
Mailing Address - Fax:508-668-3381
Practice Address - Street 1:841 MAIN ST
Practice Address - Street 2:SUITE 4
Practice Address - City:WALPOLE
Practice Address - State:MA
Practice Address - Zip Code:02081-2997
Practice Address - Country:US
Practice Address - Phone:508-498-0766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6302103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0522287Medicaid
MAW05073OtherBLUE CROSS BLUE SHIELD