Provider Demographics
NPI:1366413841
Name:STYRON, CHARLES WOODROW JR (PSY D)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:WOODROW
Last Name:STYRON
Suffix:JR
Gender:M
Credentials:PSY D
Other - Prefix:
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Mailing Address - Street 1:35 WAVERLEY ST
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:MA
Mailing Address - Zip Code:02478-1958
Mailing Address - Country:US
Mailing Address - Phone:617-489-5848
Mailing Address - Fax:617-489-5848
Practice Address - Street 1:173 MOUNT AUBURN ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-4005
Practice Address - Country:US
Practice Address - Phone:617-489-5848
Practice Address - Fax:617-489-5848
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-31
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA6388103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW05271OtherBLUE CROSS
MA95899OtherMANAGED HEALTH CARE
MA0526916Medicaid
MA6153012OtherUNITED BEHAVIORAL HEALTH
MA330623OtherHARVARD PILGRIM HEALTH CA
MA103012OtherCIGNA
MA0526916Medicaid