Provider Demographics
NPI:1508928375
Name:SCHWARTZ, CHARLES (EDD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:SCHWARTZ
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 PLEASANT VALLEY WAY
Mailing Address - Street 2:SUITE 205
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-2988
Mailing Address - Country:US
Mailing Address - Phone:973-243-0777
Mailing Address - Fax:
Practice Address - Street 1:412 PLEASANT VALLEY WAY
Practice Address - Street 2:SUITE 205
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-2988
Practice Address - Country:US
Practice Address - Phone:973-243-0777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S100029500103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ560462Medicare ID - Type Unspecified