Provider Demographics
NPI:1295044980
Name:VERNON, CHARLENE (INTERN)
Entity Type:Individual
Prefix:
First Name:CHARLENE
Middle Name:
Last Name:VERNON
Suffix:
Gender:F
Credentials:INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9027 SUTPHIN BLVD
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11435-3631
Mailing Address - Country:US
Mailing Address - Phone:718-526-8400
Mailing Address - Fax:718-297-8658
Practice Address - Street 1:9027 SUTPHIN BLVD
Practice Address - Street 2:5TH FLOOR
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11435-3631
Practice Address - Country:US
Practice Address - Phone:718-526-8400
Practice Address - Fax:718-297-8658
Is Sole Proprietor?:No
Enumeration Date:2010-09-29
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker