Provider Demographics
NPI:1063079291
Name:CHARLIEN, KERLINE
Entity type:Individual
Prefix:
First Name:KERLINE
Middle Name:
Last Name:CHARLIEN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2903 SECANE DR
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19154-1329
Mailing Address - Country:US
Mailing Address - Phone:267-274-7976
Mailing Address - Fax:
Practice Address - Street 1:5221 ARBOR ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19120-3603
Practice Address - Country:US
Practice Address - Phone:267-274-7976
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-22
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst