Provider Demographics
NPI:1083617252
Name:LEPKOWSKY, CHARLES MICHAEL (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:MICHAEL
Last Name:LEPKOWSKY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1143 DEER TRAIL LN
Mailing Address - Street 2:
Mailing Address - City:SOLVANG
Mailing Address - State:CA
Mailing Address - Zip Code:93463-9519
Mailing Address - Country:US
Mailing Address - Phone:805-688-1229
Mailing Address - Fax:805-686-9382
Practice Address - Street 1:1143 DEER TRAIL LN
Practice Address - Street 2:
Practice Address - City:SOLVANG
Practice Address - State:CA
Practice Address - Zip Code:93463-9519
Practice Address - Country:US
Practice Address - Phone:805-688-1229
Practice Address - Fax:805-686-9382
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-23
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 9118103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC107937OtherTRICARE
CA0004226734OtherAETNA
CP9118OtherMEDICARE PTAN
CP9118OtherMEDICARE PTAN