Provider Demographics
NPI:1215173232
Name:CHARLANOW, JULIE (CSAC)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:CHARLANOW
Suffix:
Gender:F
Credentials:CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:CORNING
Mailing Address - State:NY
Mailing Address - Zip Code:14830-2514
Mailing Address - Country:US
Mailing Address - Phone:607-937-6201
Mailing Address - Fax:
Practice Address - Street 1:114 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:CORNING
Practice Address - State:NY
Practice Address - Zip Code:14830-2514
Practice Address - Country:US
Practice Address - Phone:607-937-6201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-22
Last Update Date:2008-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0710102089101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)