Provider Demographics
NPI:1407013378
Name:NUGENT, CHARLOTTE M (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CHARLOTTE
Middle Name:M
Last Name:NUGENT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 PARK TER W
Mailing Address - Street 2:E80
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10034-1308
Mailing Address - Country:US
Mailing Address - Phone:212-982-8835
Mailing Address - Fax:212-304-9130
Practice Address - Street 1:853 BROADWAY
Practice Address - Street 2:STE. 1608
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-4703
Practice Address - Country:US
Practice Address - Phone:212-982-8835
Practice Address - Fax:212-304-9130
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR048748-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical