Provider Demographics
NPI:1780864157
Name:KLUCHER, CHARLOTTE MAE (MA)
Entity Type:Individual
Prefix:MS
First Name:CHARLOTTE
Middle Name:MAE
Last Name:KLUCHER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 N CEDAR CREST BLVD
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-3437
Mailing Address - Country:US
Mailing Address - Phone:610-437-0182
Mailing Address - Fax:610-437-0182
Practice Address - Street 1:825 N CEDAR CREST BLVD
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-3437
Practice Address - Country:US
Practice Address - Phone:610-437-0182
Practice Address - Fax:610-437-0182
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-13
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS007040L103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool