Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 122 | DE |
NPI | 1073636965 |
---|---|
Provider Name | Dr. Charles L Beale |
First Address | Lincoln University, PA 19352-9012 |
Second Address | Newark, DE 19711-2238 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2007 |
Last Update Date | 08/07/2007 |