Provider Demographics
NPI:1174819858
Name:CHARLES, AMY N (MSW)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:N
Last Name:CHARLES
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25415 THOREAU WAY
Mailing Address - Street 2:
Mailing Address - City:STEVENSON RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:91381-1422
Mailing Address - Country:US
Mailing Address - Phone:661-799-5979
Mailing Address - Fax:
Practice Address - Street 1:25415 THOREAU WAY
Practice Address - Street 2:
Practice Address - City:STEVENSON RANCH
Practice Address - State:CA
Practice Address - Zip Code:91381-1422
Practice Address - Country:US
Practice Address - Phone:661-799-5979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-21
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker