Provider Demographics
NPI:1932406998
Name:JONASSAINT, CHARLES RICHARD (PHD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:RICHARD
Last Name:JONASSAINT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1412 NORTHGATE RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-1549
Mailing Address - Country:US
Mailing Address - Phone:919-219-7481
Mailing Address - Fax:
Practice Address - Street 1:2024 E MONUMENT ST
Practice Address - Street 2:SUITE 1-500D
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287-0007
Practice Address - Country:US
Practice Address - Phone:410-502-8696
Practice Address - Fax:410-502-6446
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-26
Last Update Date:2011-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist