Healthcare Provider Details

I. General information

NPI: 1376014902
Provider Name (Legal Business Name): CHARMAINE B. WEBLEY NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHARMAINE B WEBLEY FNP, PMHNP

II. Dates (important events)

Enumeration Date: 12/07/2018
Last Update Date: 09/12/2025
Certification Date: 09/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 BILTMORE ST
SPRINGFIELD MA
01108-2613
US

IV. Provider business mailing address

57 BILTMORE ST
SPRINGFIELD MA
01108-2613
US

V. Phone/Fax

Practice location:
  • Phone: 413-579-8808
  • Fax: 754-799-2825
Mailing address:
  • Phone: 413-579-8808
  • Fax: 754-799-2825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number269816
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number269816
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number8457
License Number StateCT
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number8457
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: