Basic Information
| Provider Information | |||||||||
| NPI: | 1447281282 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HARNEY | ||||||||
| FirstName: | CHARLES | ||||||||
| MiddleName: | LEE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | AUDIOLOGIST | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10455 RIVERSIDE DR. | ||||||||
| Address2: | |||||||||
| City: | PALM BEACH GARDENS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33410 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5614788770 | ||||||||
| FaxNumber: | 5615987230 | ||||||||
| Practice Location | |||||||||
| Address1: | 3134 LAKE WASHINGTON RD | ||||||||
| Address2: | |||||||||
| City: | MELBOURNE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32934 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3212549919 | ||||||||
| FaxNumber: | 7877220015 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2006 | ||||||||
| LastUpdateDate: | 11/09/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | 103 | PR | N | Speech, Language and Hearing Service Providers | Audiologist | 231H00000X | FL | Y | Speech, Language and Hearing Service Providers | Audiologist |
ID Information
| ID | Type | State | Issuer | Description | 2322 | 01 | PR | INTERNATIONAL MEDICAL CAR | OTHER | 451710 | 01 | PR | CIGNA | OTHER | 660-38-4383 | 01 | PR | MCS | OTHER | 250000 | 01 | PR | UTI | OTHER | 660-38-4383 | 01 | PR | CANADA LIFE | OTHER | 660-38-4383 | 01 | PR | TRICARE | OTHER | 450004 | 01 | PR | HUMANA HEALTH | OTHER | AD-00103 | 01 | PR | UIA | OTHER | 660-38-4383 | 01 | PR | PALIC | OTHER | 660384383 | 01 | PR | FIRST PLUS | OTHER |