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General NPI Number Information
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NPI Number | 1245472943
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Entity Type | Organization
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Legal Business Name | JC CHARLIE, INC.
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Dates
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Enumeration Date | 03/27/2009
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Last Update Date | 03/27/2009
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Provider Practice Location Address
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Address Line | 650 WASHINGTON RD SUITE 130
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City | PITTSBURGH
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State | PA
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Zip | 15228-2702
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Country | US
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Telephone | 412-779-4131
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Fax |
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Provider Business Mailing Address
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Address Line | 650 WASHINGTON RD SUITE 130
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City | PITTSBURGH
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State | PA
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Zip | 15228-2702
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Country | US
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Telephone | 412-779-4131
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. LISA SUZANNE SCHWARZ
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Credential | M.ED
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Telephone | 412-221-3211
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PS-007378-L
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License Number State | PA
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