Provider Demographics
NPI:1952479891
Name:VON OHLEN, CHARLENE (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHARLENE
Middle Name:
Last Name:VON OHLEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 FIRST LT. FERRIS CT.
Mailing Address - Street 2:
Mailing Address - City:PEARL RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:10965-2748
Mailing Address - Country:US
Mailing Address - Phone:914-391-6534
Mailing Address - Fax:
Practice Address - Street 1:572 ROUTE 303
Practice Address - Street 2:
Practice Address - City:BLAUVELT
Practice Address - State:NY
Practice Address - Zip Code:10913-1941
Practice Address - Country:US
Practice Address - Phone:845-398-0934
Practice Address - Fax:845-398-0913
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010271103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist