Provider Demographics
NPI:1558359208
Name:SCHUBERT, MICHAEL LAURY (PHD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:LAURY
Last Name:SCHUBERT
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 1:120 E 34TH ST
Mailing Address - Street 2:SUITE 11G
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-4609
Mailing Address - Country:US
Mailing Address - Phone:212-532-2635
Mailing Address - Fax:212-532-2635
Practice Address - Street 1:120 E 34TH ST
Practice Address - Street 2:SUITE 11G
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-4609
Practice Address - Country:US
Practice Address - Phone:212-532-2635
Practice Address - Fax:212-532-2635
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-07
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4522103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical