Active NPI
Laurie A Charles, LCSW
- Mental Health Counselor
- Jamestown, NY
National Provider Identifier
1467572560
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- R031417-1
- Practice address
- 51 Glasgow Ave
Jamestown, NY 14701-6413 - Phone
- (716) 664-8630
- Fax
- (716) 664-8632
- NPI assigned
- Mar 30, 2007
- Last updated
- Jul 8, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | R031417-1 | NY | Primary |
Addresses
Primary practice location
51 Glasgow Ave
Jamestown, NY 14701-6413
Mailing address
51 Glasgow Ave
Jamestown, NY 14701-6413
Phone (716) 664-8630
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| R031417-1 | Other | NY | LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R031417-1 | NY | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175212800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1467572560",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "51 GLASGOW AVE",
"city": "JAMESTOWN",
"state": "NY",
"postal_code": "147016413",
"telephone_number": "716-664-8630",
"fax_number": "716-664-8632"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "51 GLASGOW AVE",
"city": "JAMESTOWN",
"state": "NY",
"postal_code": "147016413",
"telephone_number": "716-664-8630",
"fax_number": "716-664-8632"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHARLES",
"first_name": "LAURIE",
"middle_name": "A",
"name_prefix": "Mrs.",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-03-30",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "NY",
"license": "R031417-1",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE",
"identifier": "R031417-1",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Jamestown, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.