Provider Demographics
NPI:1528090842
Name:CAID, CHARLENE D (PHD)
Entity type:Individual
Prefix:
First Name:CHARLENE
Middle Name:D
Last Name:CAID
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2524 NOTTINGHAM ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77005-1412
Mailing Address - Country:US
Mailing Address - Phone:713-526-3218
Mailing Address - Fax:713-526-4342
Practice Address - Street 1:2524 NOTTINGHAM ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77005-1412
Practice Address - Country:US
Practice Address - Phone:713-526-3218
Practice Address - Fax:713-526-4342
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2-3428103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX10008948OtherAMERIGROUP
TX044152OtherVALUE OPTIONS
TX00D88BOtherBLUE CROSS BLUE SHIELD
TX032714001Medicaid
TX00D88BMedicare ID - Type UnspecifiedMEDICARE