Provider Demographics
NPI:1699831875
Name:COLOSIMO, CHARLES PHILIP (PH D)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:PHILIP
Last Name:COLOSIMO
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 S RANCHO DR STE C14
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-4831
Mailing Address - Country:US
Mailing Address - Phone:702-384-7433
Mailing Address - Fax:702-366-1204
Practice Address - Street 1:501 S RANCHO DR STE C14
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4831
Practice Address - Country:US
Practice Address - Phone:702-384-7433
Practice Address - Fax:702-366-1204
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPY0236103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical