Provider Demographics
NPI:1568750883
Name:SCHWED, STACY L (LCSW)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:L
Last Name:SCHWED
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 RUMFORD RD
Mailing Address - Street 2:
Mailing Address - City:KINGS PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11754-4113
Mailing Address - Country:US
Mailing Address - Phone:516-680-5967
Mailing Address - Fax:
Practice Address - Street 1:2240 WILLOW ST
Practice Address - Street 2:
Practice Address - City:WANTAGH
Practice Address - State:NY
Practice Address - Zip Code:11793-4225
Practice Address - Country:US
Practice Address - Phone:516-680-5967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-20
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR056086-011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY11307460OtherCAQH