Provider Demographics
NPI:1083450340
Name:FUCHS, CHARLES-ANTHONY MARK (LMSW)
Entity type:Individual
Prefix:
First Name:CHARLES-ANTHONY
Middle Name:MARK
Last Name:FUCHS
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 OLD POST RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT SINAI
Mailing Address - State:NY
Mailing Address - Zip Code:11766-1100
Mailing Address - Country:US
Mailing Address - Phone:631-652-5001
Mailing Address - Fax:
Practice Address - Street 1:468 NEIGHBORHOOD ROAD
Practice Address - Street 2:468 NEIGHBORHOOD ROAD
Practice Address - City:MASTIC BEACH
Practice Address - State:NY
Practice Address - Zip Code:11951
Practice Address - Country:US
Practice Address - Phone:631-772-6219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-06
Last Update Date:2024-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1239261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty