Provider Demographics
NPI:1447341565
Name:MOBAYED, CHARLES PAUL (PHD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:PAUL
Last Name:MOBAYED
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:49 KING RD
Mailing Address - Street 2:
Mailing Address - City:NEW IPSWICH
Mailing Address - State:NH
Mailing Address - Zip Code:03071-3613
Mailing Address - Country:US
Mailing Address - Phone:603-878-4221
Mailing Address - Fax:978-582-6190
Practice Address - Street 1:1 MAIN ST
Practice Address - Street 2:
Practice Address - City:LUNENBURG
Practice Address - State:MA
Practice Address - Zip Code:01462
Practice Address - Country:US
Practice Address - Phone:978-582-6190
Practice Address - Fax:978-582-6190
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NH694103TC0700X
MA6096103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110148825AMedicaid