Healthcare Provider Details

I. General information

NPI: 1548340730
Provider Name (Legal Business Name): CHARLES D MAURER PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 BROADWAY SUITE 315
SEATTLE WA
98122-4397
US

IV. Provider business mailing address

1001 BROADWAY SUITE 315
SEATTLE WA
98122-4397
US

V. Phone/Fax

Practice location:
  • Phone: 206-323-0905
  • Fax: 206-323-3687
Mailing address:
  • Phone: 206-323-0905
  • Fax: 206-323-3687

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number519
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: