Provider Demographics
NPI:1740993633
Name:EARLE, CHARLOTTE JOCELYN
Entity type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:JOCELYN
Last Name:EARLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16649 RUNNYMEDE ST
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91406-2835
Mailing Address - Country:US
Mailing Address - Phone:310-876-7329
Mailing Address - Fax:
Practice Address - Street 1:16649 RUNNYMEDE ST
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91406-2835
Practice Address - Country:US
Practice Address - Phone:310-876-7329
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-05
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician