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NPI Code Detail

MEDICARE: CHARLINE SEVERSON M.S., M.ED., PH.D.

MEDICARE: CHARLINE SEVERSON M.S., M.ED., PH.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TS0200XSchool Psychologist

General Provider Information

NPI Number : 1356208763
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHARLINE SEVERSON M.S., M.ED., PH.D.
Provider Business Mailing Address
First Line : 3225 DEER PARK DR # 2
Second Line :
City : STOCKTON
State : CA
Zip : 95219-2376
Country : US
Telephone Number : 209-953-8768
Fax Number :
Provider Business Practice Location Address
First Line : 3225 DEER PARK DR # 2
Second Line :
City : STOCKTON
State : CA
Zip : 95219-2376
Country : US
Telephone Number : 209-953-8768
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/07/2026
Last Update Date : 01/07/2026

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