Provider Demographics
NPI:1639215692
Name:SCHAFER-BANNAN, HALINA JACQUELINE (LCSW-R, CASAC)
Entity Type:Individual
Prefix:MS
First Name:HALINA
Middle Name:JACQUELINE
Last Name:SCHAFER-BANNAN
Suffix:
Gender:F
Credentials:LCSW-R, CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 CANDLEWOOD MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:NEW MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06776-5810
Mailing Address - Country:US
Mailing Address - Phone:860-354-4558
Mailing Address - Fax:
Practice Address - Street 1:20 MANCHESTER RD
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603-2412
Practice Address - Country:US
Practice Address - Phone:845-486-2950
Practice Address - Fax:845-486-2999
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY11333101YA0400X
NYR045023-11041C0700X
CT0059061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical