Provider Demographics
NPI:1912554239
Name:FERDSCHNEIDER, ROBERTA (LMSW)
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:
Last Name:FERDSCHNEIDER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:857 MARCY AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11216-1973
Mailing Address - Country:US
Mailing Address - Phone:917-771-1646
Mailing Address - Fax:
Practice Address - Street 1:9201 4TH AVE # 220
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-7006
Practice Address - Country:US
Practice Address - Phone:718-238-6444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-21
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY106877104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker