Provider Demographics
NPI:1376350504
Name:SAUERWALD, CHARLES EDWIN III (LADC I)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:EDWIN
Last Name:SAUERWALD
Suffix:III
Gender:M
Credentials:LADC I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 CRESCENT ST APT 519
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02453-4398
Mailing Address - Country:US
Mailing Address - Phone:603-845-9643
Mailing Address - Fax:
Practice Address - Street 1:35 CRESCENT ST APT 519
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02453-4398
Practice Address - Country:US
Practice Address - Phone:603-845-9643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-11
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA23197101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)