Provider Demographics
NPI:1134108467
Name:PRINCE, CHARLOTTE (LCSW)
Entity Type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:
Last Name:PRINCE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 W 66TH ST
Mailing Address - Street 2:#53C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-6555
Mailing Address - Country:US
Mailing Address - Phone:212-877-0108
Mailing Address - Fax:
Practice Address - Street 1:160 W 66TH ST
Practice Address - Street 2:#54C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-6555
Practice Address - Country:US
Practice Address - Phone:917-209-2084
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY070171-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN32C61Medicare ID - Type UnspecifiedEMPIRE MEDICARE SVCS.