Healthcare Provider Details

I. General information

NPI: 1073636965
Provider Name (Legal Business Name): CHARLES L BEALE ED.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

62 N CHAPEL ST SUITE 203
NEWARK DE
19711-2238
US

IV. Provider business mailing address

508 RIDGE DR
LINCOLN UNIVERSITY PA
19352-9012
US

V. Phone/Fax

Practice location:
  • Phone: 302-369-9999
  • Fax: 610-869-4428
Mailing address:
  • Phone: 610-869-4436
  • Fax: 610-869-4428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number122
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: