Healthcare Provider Details

I. General information

NPI: 1851326524
Provider Name (Legal Business Name): CHARLES CHRISTOPHER FIUMERA PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 S GAY ST
MOUNT VERNON OH
43050-3320
US

IV. Provider business mailing address

202 S GAY ST
MOUNT VERNON OH
43050-3320
US

V. Phone/Fax

Practice location:
  • Phone: 740-392-5399
  • Fax: 740-392-5399
Mailing address:
  • Phone: 740-392-5399
  • Fax: 740-392-5399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number4983
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number4983
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number4983
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number4983
License Number StateOH
# 5
Primary TaxonomyY
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number4983
License Number StateOH
# 6
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number4983
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: