Provider Demographics
NPI:1871969329
Name:CHARLES, MICHELLE MARIE (PMHNP,LCSW; RN)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:MARIE
Last Name:CHARLES
Suffix:
Gender:F
Credentials:PMHNP,LCSW; RN
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Mailing Address - Street 1:224 W 124TH ST APT 1108
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-4938
Mailing Address - Country:US
Mailing Address - Phone:917-517-9286
Mailing Address - Fax:
Practice Address - Street 1:180 FORT WASHINGTON AVE FL 6
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3722
Practice Address - Country:US
Practice Address - Phone:212-305-3174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-19
Last Update Date:2024-09-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY095645-1104100000X
NY087700-11041C0700X
NY827298163W00000X
NY404955363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No163W00000XNursing Service ProvidersRegistered Nurse