MEDICARE: CHARPENTIER PSYCHOLOGY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1326822487
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHARPENTIER PSYCHOLOGY, LLC

Provider Business Mailing Address
First Line	:	548 WOODLAND LN
Second Line	:
City	:	NEW RICHMOND
State	:	WI
Zip	:	54017-2257
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	548 WOODLAND LN
Second Line	:
City	:	NEW RICHMOND
State	:	WI
Zip	:	54017-2257
Country	:	US
Telephone Number	:	651-303-7775
Fax Number	:

Authorized Official
Title or Position	:	LICENSED PSYCHOLOGIST
Name	:	DR. STEVEN M CHARPENTIER
Credential	:	PSYD
Telephone Number	:	651-303-7775

Provider Enumeration Date	:	08/21/2023
Last Update Date	:	08/21/2023

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