Provider Demographics
NPI:1265055784
Name:HOROWITZ, CHARLES JOSEPH (PHD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:JOSEPH
Last Name:HOROWITZ
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 1:895 ROXWOOD LANE
Mailing Address - Street 2:UNIT B
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303-2867
Mailing Address - Country:US
Mailing Address - Phone:831-402-5002
Mailing Address - Fax:303-444-0096
Practice Address - Street 1:895 ROXWOOD LANE
Practice Address - Street 2:UNIT B
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-2867
Practice Address - Country:US
Practice Address - Phone:831-402-5002
Practice Address - Fax:303-444-0096
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-19
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONLC.0012262101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health