Healthcare Provider Details

I. General information

NPI: 1861730137
Provider Name (Legal Business Name): MARJORIE HELEN CHARLOP PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2013
Last Update Date: 01/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 COLUMBIA AVE PSYCHOLOGY DEPARTMENT/CLAREMONT MCKENNA COLLEGE
CLAREMONT CA
91711-3901
US

IV. Provider business mailing address

850 COLUMBIA AVENUE PSYCHOLOGY DEPARTMENT/CLAREMONT MCKENNA COLLEGE
CLAREMONT CA
91711
US

V. Phone/Fax

Practice location:
  • Phone: 909-621-8598
  • Fax: 909-621-8419
Mailing address:
  • Phone: 909-621-8598
  • Fax: 909-621-8419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY 9238
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberPSY 9238
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPSY 9238
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License NumberPSY 9238
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License NumberPSY 9238
License Number StateCA
# 6
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberPSY 9238
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: