Provider Demographics
NPI:1265953046
Name:TAYLOR, CHARLES JOSEPH (LMSW, CASAC-T)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:JOSEPH
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:LMSW, CASAC-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6591 TERRACE CT # 3
Mailing Address - Street 2:
Mailing Address - City:MIDDLE VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11379-1632
Mailing Address - Country:US
Mailing Address - Phone:757-287-3632
Mailing Address - Fax:
Practice Address - Street 1:25 CHAPEL ST STE 604
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-1916
Practice Address - Country:US
Practice Address - Phone:718-630-2830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-30
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY33461101YA0400X
NY098988-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)