Individual
MR. CHARLES CORNWALL JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MA
Contact information
Practice address
21 MAIN ST, TOWANDA, PA 18848-1803
(570) 265-2525
(570) 265-1075
Mailing address
PO BOX 104, 202 SECOND ST., ULSTER, PA 18850-0104
(570) 358-3905
(570) 265-1075
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PS002239L
PA
Other
Enumeration date
10/02/2006
Last updated
07/08/2007
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