Provider Demographics
NPI:1700678141
Name:CHARLES, SCANDIA
Entity type:Individual
Prefix:
First Name:SCANDIA
Middle Name:
Last Name:CHARLES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 WESTMINSTER AVE APT 19
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07208-3224
Mailing Address - Country:US
Mailing Address - Phone:908-356-0385
Mailing Address - Fax:
Practice Address - Street 1:405 WESTMINSTER AVE APT 19
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07208-3224
Practice Address - Country:US
Practice Address - Phone:908-356-0385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-21
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician