Provider Demographics
NPI:1114142585
Name:CHARLESWORTH, EDWARD ALLISON (PHD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:ALLISON
Last Name:CHARLESWORTH
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 1:11407 HYLANDER DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070-1339
Mailing Address - Country:US
Mailing Address - Phone:281-469-6395
Mailing Address - Fax:
Practice Address - Street 1:10609 GRANT RD
Practice Address - Street 2:BUILDING B
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-4429
Practice Address - Country:US
Practice Address - Phone:281-469-6395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2-2200103G00000X, 103TA0700X, 103TB0200X, 103TC0700X, 103TC2200X, 103TE1100X, 103TF0000X, 103TH0004X, 103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Not Answered103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
Not Answered103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Not Answered103TE1100XBehavioral Health & Social Service ProvidersPsychologistExercise & Sports
Not Answered103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
Not Answered103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth
Not Answered103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service