Provider Demographics
NPI:1497442040
Name:LEREW, CHARLYNE DION
Entity Type:Individual
Prefix:MS
First Name:CHARLYNE
Middle Name:DION
Last Name:LEREW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 BABCOCK ST
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:AR
Mailing Address - Zip Code:72104-3210
Mailing Address - Country:US
Mailing Address - Phone:501-208-6137
Mailing Address - Fax:
Practice Address - Street 1:1625 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:AR
Practice Address - Zip Code:72104-5600
Practice Address - Country:US
Practice Address - Phone:501-337-7622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-21
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician