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General NPI Number Information
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NPI Number | 1619586708
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Entity Type | Individual
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Provider Name | CHARLIE LONDON
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Gender | Female
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Dates
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Enumeration Date | 07/24/2020
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Last Update Date | 10/05/2021
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Provider Practice Location Address
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Address Line | 33 W 60TH ST
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City | NEW YORK
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State | NY
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Zip | 10023-7905
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Country | US
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Telephone | 212-333-3444
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Fax |
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Provider Business Mailing Address
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Address Line | 3242 41ST ST APT 1C
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City | ASTORIA
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State | NY
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Zip | 11103-3517
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Country | US
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Telephone | 631-885-4550
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 114231
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License Number State | NY
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