Provider Demographics
NPI:1760688055
Name:SCHARE, MITCHELL L (PHD)
Entity Type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:L
Last Name:SCHARE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 PINETREE CT
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-1136
Mailing Address - Country:US
Mailing Address - Phone:516-769-7389
Mailing Address - Fax:631-462-1289
Practice Address - Street 1:500 N BROADWAY STE 215
Practice Address - Street 2:
Practice Address - City:JERICHO
Practice Address - State:NY
Practice Address - Zip Code:11753-2128
Practice Address - Country:US
Practice Address - Phone:516-719-6383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-23
Last Update Date:2021-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY9028103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral