Provider Demographics
NPI:1306448436
Name:CHARLES, RITA DAMIQUE (MS)
Entity type:Individual
Prefix:
First Name:RITA
Middle Name:DAMIQUE
Last Name:CHARLES
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 COLONY RD
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-2812
Mailing Address - Country:US
Mailing Address - Phone:203-583-2213
Mailing Address - Fax:
Practice Address - Street 1:4 OXFORD RD
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-3855
Practice Address - Country:US
Practice Address - Phone:203-600-8900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-13
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor