Provider Demographics
NPI:1275720039
Name:SCHNITZER WOLFSTHAL, LEIGH ELLYN (LCSW)
Entity Type:Individual
Prefix:
First Name:LEIGH
Middle Name:ELLYN
Last Name:SCHNITZER WOLFSTHAL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LEIGH
Other - Middle Name:
Other - Last Name:WOLFSTHAL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:245 E 63RD ST APT 215
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-7453
Mailing Address - Country:US
Mailing Address - Phone:646-643-1185
Mailing Address - Fax:
Practice Address - Street 1:1149-55 MYRTLE AVENUE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206
Practice Address - Country:US
Practice Address - Phone:929-722-4112
Practice Address - Fax:718-919-1535
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-26
Last Update Date:2022-01-20
Deactivation Date:2021-12-22
Deactivation Code:
Reactivation Date:2022-01-14
Provider Licenses
StateLicense IDTaxonomies
NJ44SC058833001041C0700X
NY0820871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04494473Medicaid