Provider Demographics
NPI:1689177628
Name:CENTINEO-SCHWARTZ, LORI (LCSW -LIMITED PERMIT)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:CENTINEO-SCHWARTZ
Suffix:
Gender:F
Credentials:LCSW -LIMITED PERMIT
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:
Other - Last Name:CENTINEO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:618 VANDERLYN LN
Mailing Address - Street 2:
Mailing Address - City:SLINGERLANDS
Mailing Address - State:NY
Mailing Address - Zip Code:12159-9543
Mailing Address - Country:US
Mailing Address - Phone:518-461-4957
Mailing Address - Fax:
Practice Address - Street 1:301 S ALLEN ST
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-2070
Practice Address - Country:US
Practice Address - Phone:518-489-7777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-15
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY095324-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNONEMedicaid