Provider Demographics
NPI:1245395904
Name:BURBRIDGE, CHARLES E (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:E
Last Name:BURBRIDGE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:80 KINGWOOD PARK
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-5448
Mailing Address - Country:US
Mailing Address - Phone:845-635-3214
Mailing Address - Fax:845-635-3214
Practice Address - Street 1:1421 ROUTE 44
Practice Address - Street 2:TIMOTHY PROFESSIONAL BUILDING
Practice Address - City:PLEASANT VALLEY
Practice Address - State:NY
Practice Address - Zip Code:12569-7832
Practice Address - Country:US
Practice Address - Phone:845-635-3214
Practice Address - Fax:845-635-3214
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006222103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical