Provider Demographics
NPI:1902158595
Name:CHARPENTIER, STEVEN MATTHEW (PSYD, LP)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:MATTHEW
Last Name:CHARPENTIER
Suffix:
Gender:M
Credentials:PSYD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:CLEAR LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:54005-3928
Mailing Address - Country:US
Mailing Address - Phone:715-781-9542
Mailing Address - Fax:715-430-2261
Practice Address - Street 1:137 E 3RD ST
Practice Address - Street 2:
Practice Address - City:NEW RICHMOND
Practice Address - State:WI
Practice Address - Zip Code:54017-1830
Practice Address - Country:US
Practice Address - Phone:715-781-9542
Practice Address - Fax:715-430-2261
Is Sole Proprietor?:No
Enumeration Date:2012-10-08
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4039-57103TC0700X
WI5544-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional