Provider Demographics
NPI:1639218035
Name:SOULE, CHARLES R (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:R
Last Name:SOULE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 W 95TH ST
Mailing Address - Street 2:APT. 5E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-8600
Mailing Address - Country:US
Mailing Address - Phone:646-271-9089
Mailing Address - Fax:212-305-6614
Practice Address - Street 1:20 W 86TH ST
Practice Address - Street 2:STE. 1A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-3604
Practice Address - Country:US
Practice Address - Phone:212-560-2406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012945103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY012945OtherNYS LICENSED PSYCHOLOGIST