Provider Demographics
NPI:1801176722
Name:BOARDMAN, CHARLES ALAN (LMSW)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:ALAN
Last Name:BOARDMAN
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 1:303 S BROADWAY
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:TARRYTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10591-5413
Mailing Address - Country:US
Mailing Address - Phone:781-994-7602
Mailing Address - Fax:914-631-2462
Practice Address - Street 1:303 S BROADWAY
Practice Address - Street 2:3RD FLOOR
Practice Address - City:TARRYTOWN
Practice Address - State:NY
Practice Address - Zip Code:10591-5413
Practice Address - Country:US
Practice Address - Phone:781-994-7602
Practice Address - Fax:914-631-2462
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-23
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051440-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker