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General NPI Number Information
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NPI Number | 1508035528
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Entity Type | Individual
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Provider Name | JUDITH MANGAN CHARLES LPC
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Gender | Female
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Dates
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Enumeration Date | 02/24/2008
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Last Update Date | 02/24/2008
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Provider Practice Location Address
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Address Line | 44 WESTSIDE RD
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City | WOODBURY
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State | CT
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Zip | 06798-2703
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Country | US
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Telephone | 203-263-2919
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Fax | 203-263-7612
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Provider Business Mailing Address
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Address Line | 44 WESTSIDE RD
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City | WOODBURY
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State | CT
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Zip | 06798-2703
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Country | US
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Telephone | 203-263-2919
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Fax | 203-263-7612
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 000018
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License Number State | CT
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