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General NPI Number Information
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NPI Number | 1902158595
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Entity Type | Individual
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Provider Name | STEVEN MATTHEW CHARPENTIER PSYD, LP
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Gender | Male
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Dates
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Enumeration Date | 10/08/2012
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Last Update Date | 01/09/2024
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Provider Practice Location Address
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Address Line | 137 E 3RD ST
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City | NEW RICHMOND
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State | WI
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Zip | 54017-1830
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Country | US
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Telephone | 715-781-9542
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Fax | 715-430-2261
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Provider Business Mailing Address
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Address Line | 609 5TH AVE
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City | CLEAR LAKE
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State | WI
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Zip | 54005-3928
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Country | US
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Telephone | 715-781-9542
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Fax | 715-430-2261
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 4039-57
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 5544-125
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License Number State | WI
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