Provider Demographics
NPI:1720456759
Name:CHARLOTTE CARY-BOOTHE ATR LPC
Entity type:Organization
Organization Name:CHARLOTTE CARY-BOOTHE ATR LPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CHARLOTTE
Authorized Official - Middle Name:ANNA
Authorized Official - Last Name:CARY-BOOTHE
Authorized Official - Suffix:
Authorized Official - Credentials:ATR LPC
Authorized Official - Phone:484-903-1696
Mailing Address - Street 1:598 PARDEE ST
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18042-1456
Mailing Address - Country:US
Mailing Address - Phone:484-903-1696
Mailing Address - Fax:
Practice Address - Street 1:133 N 4TH ST
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18042-3518
Practice Address - Country:US
Practice Address - Phone:484-903-1696
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-08
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC008165101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty