Provider Demographics
NPI:1346483344
Name:SCHWARTZ, DAVID BEARDSLEE (PHD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:BEARDSLEE
Last Name:SCHWARTZ
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6681
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14851-6681
Mailing Address - Country:US
Mailing Address - Phone:607-330-1886
Mailing Address - Fax:
Practice Address - Street 1:1212 TRUMANSBURG RD
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-1314
Practice Address - Country:US
Practice Address - Phone:607-330-1886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-07
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001164101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health