Provider Demographics
NPI:1437218971
Name:SCHOENBROT, STEPHEN (LCSW)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:
Last Name:SCHOENBROT
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 COLBY DR
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-8352
Mailing Address - Country:US
Mailing Address - Phone:631-486-2868
Mailing Address - Fax:631-858-0237
Practice Address - Street 1:475 E MAIN ST
Practice Address - Street 2:SUITE 214
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-3121
Practice Address - Country:US
Practice Address - Phone:631-486-2868
Practice Address - Fax:631-858-0237
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR019914-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0020953OtherGHI
NYP1011059OtherOXFORD
NY060568OtherVALUE OPTIONS
NYN33442Medicare ID - Type Unspecified