Provider Demographics
NPI:1861998197
Name:CHAREK, DANIEL B (PHD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:B
Last Name:CHAREK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:607 E CARSON ST APT 5
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15203-1005
Mailing Address - Country:US
Mailing Address - Phone:330-283-6246
Mailing Address - Fax:
Practice Address - Street 1:11685 ALPHARETTA HWY STE 170
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076
Practice Address - Country:US
Practice Address - Phone:770-663-1100
Practice Address - Fax:770-663-1101
Is Sole Proprietor?:No
Enumeration Date:2018-04-04
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103G00000X
GA00000103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist