Healthcare Provider Details

I. General information

NPI: 1548576614
Provider Name (Legal Business Name): CHARLENE MARIE NUSSEY M.ED
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2010
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 RIVER ST
WELLESLEY MA
02481-2098
US

IV. Provider business mailing address

11 BARTLETT ST
OXFORD MA
01540-1715
US

V. Phone/Fax

Practice location:
  • Phone: 774-321-5659
  • Fax:
Mailing address:
  • Phone: 774-321-5659
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number1555
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: