Individual
CHARLES ALEXANDER BRAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
830 CHALKSTONE AVE BLDG 14, PROVIDENCE, RI 02908-4734
(401) 273-7100
Mailing address
243 BROADWAY APT 3, PROVIDENCE, RI 02903-3068
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
—
Other
Enumeration date
04/09/2021
Last updated
04/09/2021
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