Healthcare Provider Details

I. General information

NPI: 1952479891
Provider Name (Legal Business Name): CHARLENE VON OHLEN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

572 ROUTE 303
BLAUVELT NY
10913-1941
US

IV. Provider business mailing address

3 FIRST LT. FERRIS CT.
PEARL RIVER NY
10965-2748
US

V. Phone/Fax

Practice location:
  • Phone: 845-398-0934
  • Fax: 845-398-0913
Mailing address:
  • Phone: 914-391-6534
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number010271
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: