Provider Demographics
NPI:1881438067
Name:WIDNER, CHARLES-CAMARIN (MSW, LGSW)
Entity type:Individual
Prefix:
First Name:CHARLES-CAMARIN
Middle Name:
Last Name:WIDNER
Suffix:
Gender:
Credentials:MSW, LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 4TH ST NW STE 115
Mailing Address - Street 2:
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56601-3155
Mailing Address - Country:US
Mailing Address - Phone:218-308-8133
Mailing Address - Fax:
Practice Address - Street 1:403 4TH ST NW STE 115
Practice Address - Street 2:
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601-3155
Practice Address - Country:US
Practice Address - Phone:218-308-8133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-21
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN341211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical