Provider Demographics
NPI:1588805493
Name:PURPER, CHARLES W III (MSW, PHD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:W
Last Name:PURPER
Suffix:III
Gender:M
Credentials:MSW, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:478 W 1ST ST
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13126-4004
Mailing Address - Country:US
Mailing Address - Phone:315-342-2170
Mailing Address - Fax:315-299-6266
Practice Address - Street 1:478 W 1ST ST
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-4004
Practice Address - Country:US
Practice Address - Phone:315-342-2170
Practice Address - Fax:315-299-6266
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-23
Last Update Date:2009-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0305001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical