Provider Demographics
NPI:1275306458
Name:CHARON, IBRAHIM (PSYD)
Entity Type:Individual
Prefix:DR
First Name:IBRAHIM
Middle Name:
Last Name:CHARON
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 140556
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00614-0556
Mailing Address - Country:US
Mailing Address - Phone:787-940-3443
Mailing Address - Fax:
Practice Address - Street 1:CARR. 638 KM 6.8 INTERIOR
Practice Address - Street 2:BO. MIRAFLORES, SECTOR LAS ARENAS
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00614
Practice Address - Country:US
Practice Address - Phone:787-940-3443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-31
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7678103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical