Provider Demographics
NPI:1982796298
Name:SORRENTINO, CHARLES P (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:P
Last Name:SORRENTINO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:266 ESSEX ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970
Mailing Address - Country:US
Mailing Address - Phone:978-741-9011
Mailing Address - Fax:978-741-8610
Practice Address - Street 1:266 ESSEX ST
Practice Address - Street 2:SUITE 2
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970
Practice Address - Country:US
Practice Address - Phone:978-741-9011
Practice Address - Fax:978-741-8610
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4598103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0005740209OtherAETNA
W04478OtherBCBS MA