MEDICARE: STEPHANIE CURLEEN CHARLES

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	175T00000X	Peer Specialist

General Provider Information

NPI Number	:	1487244372
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE CURLEEN CHARLES

Provider Business Mailing Address
First Line	:	2037 UTICA AVE STE 2
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-3234
Country	:	US
Telephone Number	:	929-260-8843
Fax Number	:	718-758-9497

Provider Business Practice Location Address
First Line	:	2037 UTICA AVE STE 2
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-3234
Country	:	US
Telephone Number	:	718-377-7757
Fax Number	:	718-758-9497

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/25/2021
Last Update Date	:	01/25/2021

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Directions to “ STEPHANIE CURLEEN CHARLES ” Practice Location

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