Provider Demographics
NPI:1902378292
Name:HOWORTH, CHARLOTTE ELLEN
Entity Type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:ELLEN
Last Name:HOWORTH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 4TH ST # 1
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11231-4510
Mailing Address - Country:US
Mailing Address - Phone:347-489-9587
Mailing Address - Fax:
Practice Address - Street 1:11 4TH ST # 1
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11231-4510
Practice Address - Country:US
Practice Address - Phone:347-489-9587
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-26
Last Update Date:2018-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0756681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical