Basic Information
| Provider Information | |||||||||
| NPI: | 1033206354 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MUNDHENK | ||||||||
| FirstName: | CHARLES | ||||||||
| MiddleName: | F | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 223 CHIEF JUSTICE CUSHING HWY STE 204 | ||||||||
| Address2: | P.O. BOX 146 | ||||||||
| City: | COHASSET | ||||||||
| State: | MA | ||||||||
| PostalCode: | 020251391 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7813830860 | ||||||||
| FaxNumber: | 7813831239 | ||||||||
| Practice Location | |||||||||
| Address1: | 223 CHIEF JUSTICE CUSHING HWY STE 204 | ||||||||
| Address2: | |||||||||
| City: | COHASSET | ||||||||
| State: | MA | ||||||||
| PostalCode: | 020251391 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7813830860 | ||||||||
| FaxNumber: | 7813831239 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/06/2006 | ||||||||
| LastUpdateDate: | 11/15/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 2752 | MA | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.