Provider Demographics
NPI:1356649248
Name:MORELAND, CHARMAINE DOLORES (LMSW)
Entity type:Individual
Prefix:MS
First Name:CHARMAINE
Middle Name:DOLORES
Last Name:MORELAND
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 WEST SIXTH STREET
Mailing Address - Street 2:
Mailing Address - City:DUNKIRK
Mailing Address - State:NY
Mailing Address - Zip Code:14048
Mailing Address - Country:US
Mailing Address - Phone:716-366-9300
Mailing Address - Fax:716-366-9411
Practice Address - Street 1:75 WEST SIXTH STREET
Practice Address - Street 2:
Practice Address - City:DUNKIRK
Practice Address - State:NY
Practice Address - Zip Code:14048
Practice Address - Country:US
Practice Address - Phone:716-366-9300
Practice Address - Fax:716-366-9411
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-02
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0756591041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool