Provider Demographics
NPI:1336529734
Name:OLBERT, CHARLES MASON (PHD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:MASON
Last Name:OLBERT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:RAIN
Other - Middle Name:MASON
Other - Last Name:OLBERT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:PO BOX 1105
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:01262-1105
Mailing Address - Country:US
Mailing Address - Phone:413-931-5239
Mailing Address - Fax:
Practice Address - Street 1:25 MAIN ST
Practice Address - Street 2:AUSTIN RIGGS CENTER
Practice Address - City:STOCKBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:01262
Practice Address - Country:US
Practice Address - Phone:413-931-5239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-02
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11490103TC0700X
NY023893103TC0700X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical