Provider Demographics
NPI:1669990529
Name:MYERS, CHARLES R (PH D)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:R
Last Name:MYERS
Suffix:
Gender:M
Credentials:PH D
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Mailing Address - Street 1:30 AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-6432
Mailing Address - Country:US
Mailing Address - Phone:802-658-0040
Mailing Address - Fax:802-658-0216
Practice Address - Street 1:30 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-6432
Practice Address - Country:US
Practice Address - Phone:802-658-0040
Practice Address - Fax:802-658-0216
Is Sole Proprietor?:No
Enumeration Date:2017-08-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VT048.0000691103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT048.0000691OtherSTATE OF VT BOARD OF PSYCHOLOGICAL EXAMINERS PSYCHOLOGIST -DOCTORATE