Provider Demographics
NPI:1093391443
Name:CHWALOWSKI, CHARLES THOMAS
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:THOMAS
Last Name:CHWALOWSKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8555 AERO DR STE 201
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1745
Mailing Address - Country:US
Mailing Address - Phone:858-244-5176
Mailing Address - Fax:
Practice Address - Street 1:8555 AERO DR STE 201
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1745
Practice Address - Country:US
Practice Address - Phone:858-244-5176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-23
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty