Provider Demographics
NPI:1508035528
Name:CHARLES, JUDITH MANGAN (LPC)
Entity Type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:MANGAN
Last Name:CHARLES
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 WESTSIDE RD
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06798-2703
Mailing Address - Country:US
Mailing Address - Phone:203-263-2919
Mailing Address - Fax:203-263-7612
Practice Address - Street 1:44 WESTSIDE RD
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:CT
Practice Address - Zip Code:06798-2703
Practice Address - Country:US
Practice Address - Phone:203-263-2919
Practice Address - Fax:203-263-7612
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-24
Last Update Date:2008-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000018101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor