Healthcare Provider Details

I. General information

NPI: 1649397696
Provider Name (Legal Business Name): CHARLES A. GARON LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 11/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 N. PLAZA DR
APACHE JUNCTION AZ
85120
US

IV. Provider business mailing address

625 N PLAZA DR
APACHE JUNCTION AZ
85120-5501
US

V. Phone/Fax

Practice location:
  • Phone: 480-983-0065
  • Fax: 480-288-5339
Mailing address:
  • Phone: 480-983-0065
  • Fax: 480-288-5339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number13960
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: