Provider Demographics
NPI:1962607770
Name:LOPRESTO, CHARLES THOMAS (PHD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:THOMAS
Last Name:LOPRESTO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1418 PUTTY HILL AVE
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-8025
Mailing Address - Country:US
Mailing Address - Phone:410-823-2699
Mailing Address - Fax:
Practice Address - Street 1:120 SISTER PIERRE DR
Practice Address - Street 2:STE. 107
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-7516
Practice Address - Country:US
Practice Address - Phone:410-828-1940
Practice Address - Fax:410-617-5341
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-20
Last Update Date:2009-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02532103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical