Provider Demographics
NPI:1235264268
Name:LAJEUNESSE, CHARLES (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:
Last Name:LAJEUNESSE
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 1:620 WYOMING AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:WEST PITTSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18643-2768
Mailing Address - Country:US
Mailing Address - Phone:570-655-1667
Mailing Address - Fax:570-602-4100
Practice Address - Street 1:620 WYOMING AVE
Practice Address - Street 2:SUITE A
Practice Address - City:WEST PITTSTON
Practice Address - State:PA
Practice Address - Zip Code:18643-2768
Practice Address - Country:US
Practice Address - Phone:570-655-1667
Practice Address - Fax:570-602-4100
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS-004215-L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist