Provider Demographics
NPI:1659620649
Name:SCHLEGEL, JEAN LEWIS
Entity Type:Individual
Prefix:DR
First Name:JEAN
Middle Name:LEWIS
Last Name:SCHLEGEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:239 LIDO BLVD # K
Mailing Address - Street 2:
Mailing Address - City:LIDO BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-5092
Mailing Address - Country:US
Mailing Address - Phone:516-897-2161
Mailing Address - Fax:
Practice Address - Street 1:239 LIDO BLVD # K
Practice Address - Street 2:
Practice Address - City:LIDO BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-5092
Practice Address - Country:US
Practice Address - Phone:516-897-2161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-05
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012761103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool