MEDICARE: DR. CHARLES STEWART HASSON PH. D LICENSED PSYCH

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
1	103G00000X	Clinical Neuropsychologist	2493	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548209034
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES STEWART HASSON PH. D LICENSED PSYCH

Provider Business Mailing Address
First Line	:	111 CHARLOTTE PL STE 302
Second Line	:
City	:	ENGLEWOOD CLIFFS
State	:	NJ
Zip	:	07632-2608
Country	:	US
Telephone Number	:	201-568-1111
Fax Number	:	201-568-0422

Provider Business Practice Location Address
First Line	:	111 CHARLOTTE PL STE 302
Second Line	:
City	:	ENGLEWOOD CLIFFS
State	:	NJ
Zip	:	07632-2608
Country	:	US
Telephone Number	:	201-568-1111
Fax Number	:	201-568-0422

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	04/11/2017

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