Provider Demographics
NPI:1235103805
Name:BANG, CHARLENE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CHARLENE
Middle Name:
Last Name:BANG
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4610 CENTER BLVD 910
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11109-5855
Mailing Address - Country:US
Mailing Address - Phone:917-509-5666
Mailing Address - Fax:917-591-4307
Practice Address - Street 1:340 EAST 24 TH STREET
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-4019
Practice Address - Country:US
Practice Address - Phone:212-585-6251
Practice Address - Fax:212-585-6052
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-13
Last Update Date:2015-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014777103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYVL3821Medicare ID - Type UnspecifiedPSYCHOLOGIST