Provider Demographics
NPI:1255400628
Name:ZELTZER, CHARLES THOMAS (PHD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:THOMAS
Last Name:ZELTZER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 MAPLE CT
Mailing Address - Street 2:SUITE 123
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-3516
Mailing Address - Country:US
Mailing Address - Phone:805-644-0100
Mailing Address - Fax:
Practice Address - Street 1:260 MAPLE CT
Practice Address - Street 2:SUITE 123
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-3516
Practice Address - Country:US
Practice Address - Phone:805-644-0100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 7864103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY 7864OtherPSYCHOLOGY LICENSE