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General NPI Number Information
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NPI Number | 1972711869
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Entity Type | Individual
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Provider Name | CHARLES IAN CORLEY L.M.H.C.
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Gender | Male
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Dates
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Enumeration Date | 05/21/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 115 E 23RD ST 12TH FLOOR
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City | NEW YORK
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State | NY
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Zip | 10010-4508
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Country | US
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Telephone | 212-505-6767
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Fax | 212-529-5600
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Provider Business Mailing Address
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Address Line | 220 PELHAM RD APT 4R
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City | NEW ROCHELLE
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State | NY
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Zip | 10805-2537
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Country | US
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Telephone | 917-701-6047
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Fax | 212-529-5600
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 002282
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License Number State | NY
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