Provider Demographics
NPI:1225875099
Name:HUTZLER, CHARLOTTE A
Entity type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:A
Last Name:HUTZLER
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 1:630 FLUSHING AVE 3RD FLOOR
Mailing Address - Street 2:MAILBOX 58
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11206
Mailing Address - Country:US
Mailing Address - Phone:718-526-9150
Mailing Address - Fax:
Practice Address - Street 1:630 FLUSHING AVE 3RD FLOOR
Practice Address - Street 2:MAILBOX 58
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206
Practice Address - Country:US
Practice Address - Phone:718-526-9150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-10
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY123626-01104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker