Provider Demographics
NPI:1659925360
Name:FALK, CHARLOTTE ELIZABETH (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHARLOTTE
Middle Name:ELIZABETH
Last Name:FALK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:BETH
Other - Middle Name:
Other - Last Name:FALK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:86 HUNTVILLE RD
Mailing Address - Street 2:
Mailing Address - City:KATONAH
Mailing Address - State:NY
Mailing Address - Zip Code:10536-1927
Mailing Address - Country:US
Mailing Address - Phone:914-523-7626
Mailing Address - Fax:
Practice Address - Street 1:185 KISCO AVE STE 602
Practice Address - Street 2:
Practice Address - City:MOUNT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549-1409
Practice Address - Country:US
Practice Address - Phone:914-523-7626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-31
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013572103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY013572OtherNEW YORK STATE PSYCHOLOGY LICENSE