Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TB0200X | Cognitive & Behavioral Psychologist | 00910 | MD |
NPI | 1245449883 |
---|---|
Provider Name | Charles S. Mansueto |
First Address | Silver Spring, MD 20903-1218 |
Second Address | Silver Spring, MD 20901-4562 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2007 |
Last Update Date | 04/01/2010 |