Provider Demographics
NPI:1518120906
Name:SCHWARTZ, GARY J (LMHC BCN)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:J
Last Name:SCHWARTZ
Suffix:
Gender:M
Credentials:LMHC BCN
Other - Prefix:
Other - First Name:GARY
Other - Middle Name:J
Other - Last Name:SCHWARTZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA BCN
Mailing Address - Street 1:4519 NE TOWNLINE RD
Mailing Address - Street 2:
Mailing Address - City:MARCELLUS
Mailing Address - State:NY
Mailing Address - Zip Code:13108-9717
Mailing Address - Country:US
Mailing Address - Phone:315-569-8173
Mailing Address - Fax:315-689-4017
Practice Address - Street 1:1551 ROUTE 20
Practice Address - Street 2:
Practice Address - City:SKANEATELES
Practice Address - State:NY
Practice Address - Zip Code:13152
Practice Address - Country:US
Practice Address - Phone:315-453-3911
Practice Address - Fax:315-453-0197
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-07
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001889101YM0800X
NY11210101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01420800Medicaid