Provider Demographics
NPI:1346607348
Name:SCHAUBROECK, PATRICK
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:
Last Name:SCHAUBROECK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 MONTGOMERY ST
Mailing Address - Street 2:4TH FLOOR EAST
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13202-2923
Mailing Address - Country:US
Mailing Address - Phone:315-435-1970
Mailing Address - Fax:315-435-7715
Practice Address - Street 1:421 MONTGOMERY ST
Practice Address - Street 2:4TH FLOOR EAST
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13202-2923
Practice Address - Country:US
Practice Address - Phone:315-435-1970
Practice Address - Fax:315-435-7715
Is Sole Proprietor?:No
Enumeration Date:2016-01-21
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY074524-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical