Provider Demographics
NPI:1629208533
Name:CHARNET, JUDITH MIRIAM (PHD)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:MIRIAM
Last Name:CHARNET
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8049 260TH ST
Mailing Address - Street 2:
Mailing Address - City:FLORAL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11004-1201
Mailing Address - Country:US
Mailing Address - Phone:718-470-1338
Mailing Address - Fax:
Practice Address - Street 1:8049 260TH ST
Practice Address - Street 2:
Practice Address - City:FLORAL PARK
Practice Address - State:NY
Practice Address - Zip Code:11004-1201
Practice Address - Country:US
Practice Address - Phone:718-470-1338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-27
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011938-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01475098Medicaid
NYV5I451OtherMEDICARE- POSSIBLY EXPIRED