Provider Demographics
NPI:1811103633
Name:WUTH, CHARLES HARLAN (LCSW)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:HARLAN
Last Name:WUTH
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 BLANCHARD PKWY
Mailing Address - Street 2:
Mailing Address - City:ALLENHURST
Mailing Address - State:NJ
Mailing Address - Zip Code:07711-1304
Mailing Address - Country:US
Mailing Address - Phone:732-517-1051
Mailing Address - Fax:
Practice Address - Street 1:608 BLANCHARD PKWY
Practice Address - Street 2:
Practice Address - City:ALLENHURST
Practice Address - State:NJ
Practice Address - Zip Code:07711-1304
Practice Address - Country:US
Practice Address - Phone:732-517-1051
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC013786001041C0700X
101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health