Provider Demographics
NPI:1962687731
Name:CHARLES, LOURNA (LCSW)
Entity Type:Individual
Prefix:
First Name:LOURNA
Middle Name:
Last Name:CHARLES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MARIE
Other - Middle Name:LOURNA
Other - Last Name:CHARLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:529 SEVEN BRIDGE RD UNIT 207
Mailing Address - Street 2:
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-7608
Mailing Address - Country:US
Mailing Address - Phone:516-305-7659
Mailing Address - Fax:
Practice Address - Street 1:529 SEVEN BRIDGE RD UNIT 207
Practice Address - Street 2:
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-7608
Practice Address - Country:US
Practice Address - Phone:516-305-7659
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-29
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 1041C0700X
PACW0203001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor