Provider Demographics
NPI:1194746990
Name:CHARALAMBIDIS, ASIMENA (PSYD)
Entity type:Individual
Prefix:DR
First Name:ASIMENA
Middle Name:
Last Name:CHARALAMBIDIS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2130 HIGH WAY 35
Mailing Address - Street 2:SUITE A114
Mailing Address - City:SEA GIRT
Mailing Address - State:NJ
Mailing Address - Zip Code:08750-1010
Mailing Address - Country:US
Mailing Address - Phone:732-974-4044
Mailing Address - Fax:732-974-5540
Practice Address - Street 1:2130 HIGHWAY 35
Practice Address - Street 2:BUILDING A SUITE 114
Practice Address - City:SEA GIRT
Practice Address - State:NJ
Practice Address - Zip Code:08750-1010
Practice Address - Country:US
Practice Address - Phone:732-974-4044
Practice Address - Fax:732-974-5540
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2936103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ511599XPQMedicare PIN