Provider Demographics
NPI:1841031663
Name:DALGLEISH, CHARLES AUSTIN
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:AUSTIN
Last Name:DALGLEISH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1419 GREENE AVE APT 3L
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11237-5028
Mailing Address - Country:US
Mailing Address - Phone:913-486-3640
Mailing Address - Fax:
Practice Address - Street 1:1419 GREENE AVE APT 3L
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11237-5028
Practice Address - Country:US
Practice Address - Phone:913-486-3640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-05
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY123585104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker