Provider Demographics
NPI:1225346695
Name:SCHIMEL, JULIE IVANS (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:IVANS
Last Name:SCHIMEL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:MS
Other - First Name:JULIE
Other - Middle Name:CATHERINE
Other - Last Name:IVANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:175 SAINT REGIS DR
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11762-3454
Mailing Address - Country:US
Mailing Address - Phone:917-968-8359
Mailing Address - Fax:
Practice Address - Street 1:2174 HEWLETT AVE STE 105
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-3612
Practice Address - Country:US
Practice Address - Phone:516-858-2877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-20
Last Update Date:2019-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020838-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY020838-1OtherPSYCHOLOGY LICENSE