Provider Demographics
NPI:1063745693
Name:LEHMAN, CHARLENE RENE (LCSW)
Entity type:Individual
Prefix:
First Name:CHARLENE
Middle Name:RENE
Last Name:LEHMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CHARLENE
Other - Middle Name:RENE
Other - Last Name:KINCAID
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1622 DARIEN DR
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46815
Mailing Address - Country:US
Mailing Address - Phone:260-927-3682
Mailing Address - Fax:858-874-8212
Practice Address - Street 1:1622 DARIEN DR
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46815
Practice Address - Country:US
Practice Address - Phone:260-927-3682
Practice Address - Fax:858-874-8212
Is Sole Proprietor?:No
Enumeration Date:2009-09-15
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34005817A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN581480WMedicare PIN