Provider Demographics
NPI:1972682391
Name:CUTLER, CHARLES M (PHD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:M
Last Name:CUTLER
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 1:16265 MESTO CT
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-3114
Mailing Address - Country:US
Mailing Address - Phone:858-521-9382
Mailing Address - Fax:
Practice Address - Street 1:16265 MESTO CT
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-3114
Practice Address - Country:US
Practice Address - Phone:858-521-9382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-05
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1754103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical