Provider Demographics
NPI:1114688108
Name:PURCHAS, CHARITY N (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:CHARITY
Middle Name:N
Last Name:PURCHAS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MS
Other - First Name:CHARITY
Other - Middle Name:N
Other - Last Name:INGOLDBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:506 MELROSE DR
Mailing Address - Street 2:
Mailing Address - City:NORTH SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13212-3725
Mailing Address - Country:US
Mailing Address - Phone:680-214-5457
Mailing Address - Fax:
Practice Address - Street 1:1045 JAMES ST STE 100
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13203-2758
Practice Address - Country:US
Practice Address - Phone:315-472-4471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-03
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY112355104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker