Basic Information
| Provider Information | |||||||||
| NPI: | 1962687731 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHARLES | ||||||||
| FirstName: | LOURNA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | LCSW | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | CHARLES | ||||||||
| OtherFirstName: | MARIE | ||||||||
| OtherMiddleName: | LOURNA | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 529 SEVEN BRIDGE RD UNIT 207 | ||||||||
| Address2: | |||||||||
| City: | EAST STROUDSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 183017608 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5163057659 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 529 SEVEN BRIDGE RD UNIT 207 | ||||||||
| Address2: | |||||||||
| City: | EAST STROUDSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 183017608 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5163057659 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/29/2007 | ||||||||
| LastUpdateDate: | 10/24/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | N | Behavioral Health & Social Service Providers | Counselor | 1041C0700X | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | CW020300 | PA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.