Provider Demographics
NPI:1891823563
Name:EMERY, CHARLES FISKE (PHD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:FISKE
Last Name:EMERY
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 1:1835 NEIL AVE
Mailing Address - Street 2:145 PSYCHOLOGY BUILDING
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43210-1351
Mailing Address - Country:US
Mailing Address - Phone:614-688-3061
Mailing Address - Fax:614-688-8261
Practice Address - Street 1:1835 NEIL AVE
Practice Address - Street 2:145 PSYCHOLOGY BUILDING
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210-1351
Practice Address - Country:US
Practice Address - Phone:614-688-3061
Practice Address - Fax:614-688-8261
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4958103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical