Provider Demographics
NPI:1053108670
Name:AZAD, CHARLOTTE CLINE (MA, SEP)
Entity type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:CLINE
Last Name:AZAD
Suffix:
Gender:
Credentials:MA, SEP
Other - Prefix:
Other - First Name:CHAR
Other - Middle Name:
Other - Last Name:KASZA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, SEP
Mailing Address - Street 1:83 HIGH ST APT 1
Mailing Address - Street 2:
Mailing Address - City:CATSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12414-1042
Mailing Address - Country:US
Mailing Address - Phone:845-399-3392
Mailing Address - Fax:
Practice Address - Street 1:344 MAIN ST APT 1
Practice Address - Street 2:
Practice Address - City:CATSKILL
Practice Address - State:NY
Practice Address - Zip Code:12414-1445
Practice Address - Country:US
Practice Address - Phone:845-399-3392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-24
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist