Provider Demographics
NPI:1316013154
Name:SCHWARTZ, SHELLEY (LCSW-R)
Entity Type:Individual
Prefix:MS
First Name:SHELLEY
Middle Name:
Last Name:SCHWARTZ
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2943 HEWLETT AVE
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-5310
Mailing Address - Country:US
Mailing Address - Phone:516-867-3768
Mailing Address - Fax:516-255-0566
Practice Address - Street 1:30 HEMPSTEAD AVE
Practice Address - Street 2:SUITE 143A
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-4033
Practice Address - Country:US
Practice Address - Phone:516-255-0566
Practice Address - Fax:516-255-0566
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049164-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02014780Medicaid
NYNOG121Medicare ID - Type UnspecifiedMENTAL HEALTH PROVIDER