Provider Demographics
NPI:1366553216
Name:PEARSON, CHARLES WOODS (MDIV, LCSW)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:WOODS
Last Name:PEARSON
Suffix:
Gender:M
Credentials:MDIV, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:158 E 35TH ST
Mailing Address - Street 2:POSTGRADUATE CENTER FOR MENTAL HEALTH
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-4102
Mailing Address - Country:US
Mailing Address - Phone:212-971-3200
Mailing Address - Fax:212-244-2034
Practice Address - Street 1:158 E 35TH ST
Practice Address - Street 2:POSTGRADUATE CENTER FOR MENTAL HEALTH
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-4102
Practice Address - Country:US
Practice Address - Phone:212-971-3200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2009-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0766661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT800002434Medicare ID - Type Unspecified