Gregory J. Charboneau, EDD, BCN, BCB

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

License

WA.LIC2046 Issued in WA

Practice address

3157 E. 17TH Avenue
Spokane, WA 99223-5136

Phone

(509) 838-8066

Fax

(800) 594-8305

NPI assigned

Oct 7, 2005

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 7

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 1985

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Greenleaf Psychology

  • Point of Service
  • Spokane, WA
  • NPI 1619420379
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1128643200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1352851200000",
    "number": "1790773463",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3157 E. 17TH AVENUE",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992235136",
            "telephone_number": "509-838-8066",
            "fax_number": "800-594-8305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3157 E. 17TH AVENUE",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992235136",
            "telephone_number": "509-838-8066",
            "fax_number": "800-594-8305"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHARBONEAU",
        "first_name": "GREGORY",
        "middle_name": "J.",
        "name_prefix": "Dr.",
        "credential": "EDD, BCN, BCB",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-10-07",
        "last_updated": "2012-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "WA",
            "license": "2046",
            "primary": false
        },
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "WA",
            "license": "WA.LIC2046",
            "primary": true
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TB0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TH0004X",
            "taxonomy_group": "",
            "desc": "Psychologist, Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TH0100X",
            "taxonomy_group": "",
            "desc": "Psychologist, Health Service",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "APA#",
            "identifier": "80159590",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Megan Mary Chapman
• Dena Marie Chappell
• Dylan Chappell
• George Johnston Chappell, CDP
• Kasey Therene Chappell, BA
• Edward Lee Charbonneau, DDS
• Merry Louise Charbonneau
• Charles Gallagher PT, PS
• Charles H. Greensword, D.C.,PLLC
• Thomas H. Charles, P.A.

• Clinical Neuropsychologist in Spokane, WA
• Providers in Spokane, WA by specialty
• Clinical Neuropsychologist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.