Provider Demographics
NPI:1477036044
Name:LETTS, CHARLENE
Entity type:Individual
Prefix:MS
First Name:CHARLENE
Middle Name:
Last Name:LETTS
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:CHARLENE
Other - Middle Name:
Other - Last Name:LETTS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW
Mailing Address - Street 1:1835 NEEDHAM AVE APT 4L
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466-6303
Mailing Address - Country:US
Mailing Address - Phone:929-333-0437
Mailing Address - Fax:
Practice Address - Street 1:1835 NEEDHAM AVE APT 4L
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-6303
Practice Address - Country:US
Practice Address - Phone:929-333-0437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-10
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY87569104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY87569Medicaid
87567OtherUNIVERSITY OF MY EDUCATION DEPARTMENT