Provider Demographics
NPI:1700921673
Name:CHARLES E. STREFF
Entity type:Organization
Organization Name:CHARLES E. STREFF
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:E
Authorized Official - Last Name:STREFF
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:978-263-0439
Mailing Address - Street 1:532 GREAT RD
Mailing Address - Street 2:
Mailing Address - City:ACTON
Mailing Address - State:MA
Mailing Address - Zip Code:01720-3415
Mailing Address - Country:US
Mailing Address - Phone:978-263-0439
Mailing Address - Fax:978-486-3140
Practice Address - Street 1:532 GREAT RD
Practice Address - Street 2:
Practice Address - City:ACTON
Practice Address - State:MA
Practice Address - Zip Code:01720-3415
Practice Address - Country:US
Practice Address - Phone:978-263-0439
Practice Address - Fax:978-486-3140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW10613OtherBLUE CROSS
MA612861OtherTUFTS