Individual
CHARLES PIERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
419 WALNUT AVE, NIAGARA FALLS, NY 14301-1725
(716) 285-1904
(716) 284-8262
Mailing address
24 ARDMORE PL, BUFFALO, NY 14213-1446
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
015190-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00026277402
UNIVERA
NY
01
—
000527125002
BC
NY
01
—
6111636
IHA
NY
Enumeration date
08/18/2006
Last updated
07/08/2007
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