Basic Information
| Provider Information | |||||||||
| NPI: | 1851565410 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BUDRIUS | ||||||||
| FirstName: | CHARLENE | ||||||||
| MiddleName: | A. | ||||||||
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| NameSuffix: | I | ||||||||
| Credential: | CNS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9 ADDISON ST | ||||||||
| Address2: | |||||||||
| City: | ARLINGTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 024768107 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7816434530 | ||||||||
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| Practice Location | |||||||||
| Address1: | 169 ELM ST | ||||||||
| Address2: | |||||||||
| City: | WALTHAM | ||||||||
| State: | MA | ||||||||
| PostalCode: | 024535356 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7818948440 | ||||||||
| FaxNumber: | 7818941202 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/15/2008 | ||||||||
| LastUpdateDate: | 04/15/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 364SP0809X | 115701 | MA | Y | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psych/Mental Health, Adult |
ID Information
| ID | Type | State | Issuer | Description | 1303287 | 05 | MA | MEDICAID | 703136 | 01 | MA | TUFTS | OTHER | 0023532 | 01 | MA | BMC | OTHER | 1303287 | 01 | MA | MBHP | OTHER | H1004745 | 01 | MA | NHP | OTHER | 99618201 | 01 | MA | NETWORK HEALTH | OTHER | CP0110 | 01 | MA | BCBS | OTHER |