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General NPI Number Information
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NPI Number | 1003981986
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Entity Type | Individual
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Provider Name | MICHAEL ALAN CHARASH PH.D.
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Gender | Male
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Dates
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Enumeration Date | 11/23/2006
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Last Update Date | 04/28/2020
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Provider Practice Location Address
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Address Line | 725 N 12TH AVE BLDG B
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City | ARCADIA
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State | FL
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Zip | 34266-8752
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Country | US
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Telephone | 863-494-1242
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Fax | 863-491-0466
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Provider Business Mailing Address
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Address Line | 121 TARA OAKS CIR
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City | LADY LAKE
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State | FL
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Zip | 32159-8305
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Country | US
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Telephone | 561-271-1570
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | PY6981
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PY6981
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License Number State | FL
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