Provider Demographics
NPI:1093767055
Name:MCCREARY, CHARLES PATRICK (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:PATRICK
Last Name:MCCREARY
Suffix:
Gender:M
Credentials:PHD
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Mailing Address - Street 1:11301 WILSHIRE BLVD
Mailing Address - Street 2:GLAVA HEALTH CENTER 116B
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90073-1003
Mailing Address - Country:US
Mailing Address - Phone:310-268-4393
Mailing Address - Fax:310-268-4775
Practice Address - Street 1:11301 WILSHIRE BLVD
Practice Address - Street 2:GLAVA HEALTH CENTER 116B
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90073-1003
Practice Address - Country:US
Practice Address - Phone:310-268-4393
Practice Address - Fax:310-268-4775
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPSY3867103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical