Provider Demographics
NPI:1679831952
Name:SCHAEFER, THOMAS (LCSW-R)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:SCHAEFER
Suffix:
Gender:M
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:198 ASPEN ST
Mailing Address - Street 2:
Mailing Address - City:FLORAL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11001-3432
Mailing Address - Country:US
Mailing Address - Phone:516-488-6022
Mailing Address - Fax:
Practice Address - Street 1:198 ASPEN ST
Practice Address - Street 2:
Practice Address - City:FLORAL PARK
Practice Address - State:NY
Practice Address - Zip Code:11001-3432
Practice Address - Country:US
Practice Address - Phone:516-488-6022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-24
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR055279-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker