Provider Demographics
NPI:1386091221
Name:CHARRY, EDNA
Entity type:Individual
Prefix:
First Name:EDNA
Middle Name:
Last Name:CHARRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7103 NW 174TH TER
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-1182
Mailing Address - Country:US
Mailing Address - Phone:786-448-7151
Mailing Address - Fax:
Practice Address - Street 1:7103 NW 174TH TER
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-1182
Practice Address - Country:US
Practice Address - Phone:786-448-7151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-20
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst