Provider Demographics
NPI:1376788273
Name:SEARS, CHARLENA DENISE (PSYD)
Entity Type:Individual
Prefix:
First Name:CHARLENA
Middle Name:DENISE
Last Name:SEARS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 CHURCH ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-4441
Mailing Address - Country:US
Mailing Address - Phone:973-744-8725
Mailing Address - Fax:973-744-1967
Practice Address - Street 1:50 CHURCH ST
Practice Address - Street 2:SUITE 105
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-4441
Practice Address - Country:US
Practice Address - Phone:973-744-8725
Practice Address - Fax:973-744-1967
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-05
Last Update Date:2008-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S100282100103TC0700X
NY10862103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical