Charles B Mark, PSY.D.
Individual provider Active NPI Clinical Psychologist · Oldwick, NJ
NPI 1689767600 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1689767600
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Psychologist 103TC0700X
- License
- 1712 (NJ)
- Practice address
- 48 Old Turnpike Rd
Oldwick, NJ 08858 - Phone
- (908) 439-3456
- Fax
- (908) 439-2343
- NPI assigned
- Oct 2, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Clinical Psychologist
- Education
- Other, 1980
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
Bloomsbury, NJ 08804
Phone (908) 528-3039
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NJ
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20110815000533 | NJ | Practitioner - Clinical Psychologist | 5799954475 | Practice locations: Bloomsbury, NJ |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1712 | NJ | MD | Clinical Psychologist |
| PS-004600-L | PA | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Oldwick Associates in Psychotherapy LLC | Clinical | Past |
Accepting new patients |
| Dream and Play Psychological Services LLC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 1712 | NJ | Yes |
| Clinical Psychologist | 103TC0700X | PS-004600-L | PA |
Addresses
Primary practice location
48 Old Turnpike Rd
Oldwick, NJ 08858
Mailing address
PO Box 242
Oldwick, NJ 08858-0242
Phone (908) 439-3456
Other providers in Oldwick, NJ
- Legacy Treatment Services
- Deborah Z. Libero
- Katrina Low-Beer
- Marla Guariglia Lustig
- Mane Stream, Inc.
- Tracy A. Menzie
- Oldwick Cosmetic & Family Dentistry - Oldwick
- Linda S Oniki
- Riverside Psychiatric Health
- Virginia S Walters
All providers in Oldwick, NJ · Clinical Psychologist in New Jersey
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.