Individual
DR. CHARLES JACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
5178 PARKER RD, HAMBURG, NY 14075
(716) 598-8827
Mailing address
5178 PARKER RD, HAMBURG, NY 14075
(716) 598-8827
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
—
—
103TC0700X
Clinical Psychologist
Primary
35SI00726500
NJ
Other
Enumeration date
12/02/2021
Last updated
11/24/2023
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