Provider Demographics
NPI:1740154863
Name:AVENA, CHARLES M (LMSW)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:M
Last Name:AVENA
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9433 S OCEAN DR APT 7C
Mailing Address - Street 2:
Mailing Address - City:JENSEN BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:34957-2378
Mailing Address - Country:US
Mailing Address - Phone:772-217-4593
Mailing Address - Fax:860-540-1616
Practice Address - Street 1:9433 S OCEAN DR APT 7C
Practice Address - Street 2:
Practice Address - City:JENSEN BEACH
Practice Address - State:FL
Practice Address - Zip Code:34957-2378
Practice Address - Country:US
Practice Address - Phone:240-575-2203
Practice Address - Fax:240-877-0511
Is Sole Proprietor?:No
Enumeration Date:2025-10-01
Last Update Date:2025-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT61104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker