Basic Information
| Provider Information | |||||||||
| NPI: | 1861998197 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHAREK | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | B | ||||||||
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| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 607 E CARSON ST APT 5 | ||||||||
| Address2: | |||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152031005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3302836246 | ||||||||
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| Practice Location | |||||||||
| Address1: | 11685 ALPHARETTA HWY STE 170 | ||||||||
| Address2: | |||||||||
| City: | ROSWELL | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30076 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7706631100 | ||||||||
| FaxNumber: | 7706631101 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/04/2018 | ||||||||
| LastUpdateDate: | 02/26/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103G00000X | N | Behavioral Health & Social Service Providers | Clinical Neuropsychologist | 103G00000X | 00000 | GA | Y | Behavioral Health & Social Service Providers | Clinical Neuropsychologist |
No ID Information.