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General NPI Number Information
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NPI Number | 1932544277
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Entity Type | Organization
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Legal Business Name | CHARLES ASSAD, PH.D.
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Dates
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Enumeration Date | 04/30/2013
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Last Update Date | 05/01/2013
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Provider Practice Location Address
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Address Line | 1202 SE 8TH PL UNIT C
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City | CAPE CORAL
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State | FL
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Zip | 33990-2113
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Country | US
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Telephone | 239-772-3488
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Fax | 239-772-3688
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Provider Business Mailing Address
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Address Line | 1202 SE 8TH PL UNIT C
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City | CAPE CORAL
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State | FL
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Zip | 33990-2113
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Country | US
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Telephone | 239-772-3488
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Fax | 239-772-3688
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | DR. CHARLES ASSAD
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Credential | PH.D.
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Telephone | 239-772-3488
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PY 7446
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License Number State | FL
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