Charles Woodrow Styron Jr., PSY. D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

6388 Issued in MA

Practice address

173 Mount Auburn St
Watertown, MA 02472-4005

Phone

(617) 489-5848

Fax

(617) 489-5848

NPI assigned

Jan 31, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 6

Medicare fee-for-service enrollment

Enrolled in MA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 1991

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Boston Health Care IncGroup PAC ID 0244218360, 10 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Boston Healthcare Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Walpole, MA
  • NPI 1821065640
  Medicare reassignment Care Compare group NPD
• Walpole Physical Therapy Services, Inc

  • Physical Therapist
  • Walpole, MA
  • NPI 1477675916
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1138665600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1280448000000",
    "number": "1366413841",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "35 WAVERLEY ST",
            "city": "BELMONT",
            "state": "MA",
            "postal_code": "024781958",
            "telephone_number": "617-489-5848",
            "fax_number": "617-489-5848"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "173 MOUNT AUBURN ST",
            "city": "WATERTOWN",
            "state": "MA",
            "postal_code": "024724005",
            "telephone_number": "617-489-5848",
            "fax_number": "617-489-5848"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STYRON",
        "first_name": "CHARLES",
        "middle_name": "WOODROW",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "PSY. D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-01-31",
        "last_updated": "2010-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MA",
            "license": "6388",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "W05271",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MANAGED HEALTH CARE",
            "identifier": "95899",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0526916",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED BEHAVIORAL HEALTH",
            "identifier": "6153012",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HARVARD PILGRIM HEALTH CA",
            "identifier": "330623",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "103012",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mark Strokowski, DMD
• Ana Laura Stuart, OTR/L
• Janice Stubblefield-Tave, MA, LICSW
• Lyn E Styczynski, PHD
• Jamie Styer
• Sophia Carmen Suarez-Friedman, LICSW
• Sun Health Systems
• Sun Health Systems
• Kathryn Sutherland
• Morgan Sutherland

• Clinical Psychologist in Watertown, MA
• Providers in Watertown, MA by specialty
• Clinical Psychologist in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.