DR. CHARLES BENJAMIN JARDIN (NPI# 1770133548) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1770133548 |
| Entity Type | Individual |
| Full Name | DR. CHARLES BENJAMIN JARDIN |
| Credential | PH.D. |
| Practice Address |
508 Fulton St # 116d Durham NC 27705-3875 |
| Mailing Address |
204 Dogwood Bloom Ln Hillsborough NC 27278-9095 |
| Practice Telephone | 9192860411 |
| Mailing Telephone | 9196727750 |
| Enumeration Date | 2019-09-13 |
| Last Update Date | 2019-09-13 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 103TA0400X |
Psychologist Specialization: Addiction (Substance Use Disorder) |
Behavioral Health & Social Service Providers | ||
| N | 103TB0200X |
Psychologist Specialization: Cognitive & Behavioral |
Behavioral Health & Social Service Providers | ||
| Y | 103TC0700X |
Psychologist Specialization: Clinical |
5606 | NC | Behavioral Health & Social Service Providers |
| N | 103TR0400X |
Psychologist Specialization: Rehabilitation |
Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | NC PSYCHOLOGY BOARD | 5606 | 01 |
| Street Address |
508 FULTON ST # 116D |
| City | DURHAM |
| State | NC |
| Zip Code | 27705-3875 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295371755 | Tyler Beach, Lcsw, Pllc | Social Worker | 2740 Spencer Street, Durham, NC 27705 | 2019-11-20 |
| 1720635477 | Brittany W Fry | Registered Nurse | 2301 Erwin Road, Hafs Building, Room 6670, Durham, NC 27705 | 2019-08-19 |
| 1760968044 | Nicole D Moore | Social Worker | 1921 N. Pointe Dr, Suite 280, Durham, NC 27705 | 2018-07-19 |
| 1144757097 | Emileigh S Dowling | Physical Therapist | 3475 Erwin Rd Bldg 2, Durham, NC 27705 | 2017-05-22 |
| 1487195350 | Daniel Lynch | Physical Therapist | 3475 Erwin Road, Pepsico Building, Durham, NC 27705 | 2017-03-13 |
| 1780131839 | Michael A Fitzpatrick Iv | Physical Therapist | 3475 Erwin Rd Bldg 2nd, Durham, NC 27705 | 2016-09-07 |
| 1609241736 | Julia Power Constant | Physician Assistant | Dumc Box 3913, Durham, NC 27705 | 2015-12-01 |
| 1518344159 | Amanda Clark Coniglio | Internal Medicine | 2301 Erwin Rd # 3845, Durham, NC 27705 | 2015-05-04 |
| 1720486988 | Jennifer Dawn Pace | Physician Assistant | 1821 Hillandale Road Suite 24a, Duke Urgent Care, Durham, NC 27705 | 2014-12-19 |
| 1942612106 | Rachel Hibberd | Psychologist | 508 Fulton Avenue, Durham Va Medical Center, Durham, NC 27705 | 2014-05-22 |
| Find all providers in zip 27705 | ||||
| Taxonomy Code | 103TC0700X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Clinical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932708062 | Daniel Vanhoy Blalock | Psychologist | 411 W Chapel Hill St Ste 600, Durham, NC 27701-3270 | 2020-10-20 |
| 1265048342 | Joseph Giles Winger | Psychologist | 2200 W Main St Erwin Square Plaza, Durham, NC 27710-0001 | 2020-09-23 |
| 1124640537 | Katherine Ramos | Psychologist | 2200 W Main St Ste 300, Durham, NC 27705-4677 | 2020-05-08 |
| 1902436496 | Caitlin Marie Fang | Psychologist | 1200 Broad St Ste 103, Durham, NC 27705-3576 | 2020-01-23 |
| 1194376095 | Craig Daniel Libman | Psychologist | 508 Fulton St Dept 116b, Durham, NC 27705-3875 | 2019-09-23 |
| 1790346617 | Timothy Joseph Strauman | Psychologist | 708 Ivy Meadow Ln, Durham, NC 27707-6183 | 2019-06-21 |
| 1417417262 | Carmen Elisabeth Sanchez | Psychologist | 3326 Durham Chapel Hill Blvd Bldg D, Durham, NC 27707 | 2019-03-20 |
| 1881150795 | Courtney Dutton Cox | Psychologist | 508 Fulton St # 116c, Durham, NC 27705-3875 | 2019-02-15 |
| 1295290104 | Sarah E. Frost | Psychologist | 18 W Colony Pl Ste 280, Durham, NC 27705-5582 | 2019-02-05 |
| 1134639362 | Mark Edward Wolever | Psychologist | 1502 Nc Hwy 54 Wesst, Suite 406, Durham, NC 27707 | 2017-10-02 |
| Find all providers in DURHAM | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.