Provider Demographics
NPI:1942408752
Name:ANDERSON, CHARLES BRUCE (PHD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:BRUCE
Last Name:ANDERSON
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:DIRECTOR, UNH COUNSELING CENTER
Mailing Address - Street 2:300 BOSTON POST ROAD
Mailing Address - City:WEST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06516
Mailing Address - Country:US
Mailing Address - Phone:804-385-1429
Mailing Address - Fax:203-931-6082
Practice Address - Street 1:DIRECTOR, UNH COUNSELING CENTER
Practice Address - Street 2:300 BOSTON POST ROAD
Practice Address - City:WEST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06516
Practice Address - Country:US
Practice Address - Phone:804-385-1429
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810003796103TC1900X
CT003485103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling