Provider Demographics
NPI:1801002936
Name:WANIO, CHARLES P (LMHC, LMFT)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:P
Last Name:WANIO
Suffix:
Gender:M
Credentials:LMHC, LMFT
Other - Prefix:
Other - First Name:C.
Other - Middle Name:PAUL
Other - Last Name:WANIO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMHC, LMFT
Mailing Address - Street 1:PO BOX 273391
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33427-3391
Mailing Address - Country:US
Mailing Address - Phone:561-251-0202
Mailing Address - Fax:561-244-8146
Practice Address - Street 1:2200 NW CORPORATE BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-7387
Practice Address - Country:US
Practice Address - Phone:561-251-0202
Practice Address - Fax:561-244-8146
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH2102101YM0800X
FLMT1262106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist