Provider Demographics
NPI:1922163997
Name:SCHLICHTINGER, CARL TRISTAN (MSW/ LCSW)
Entity Type:Individual
Prefix:MR
First Name:CARL
Middle Name:TRISTAN
Last Name:SCHLICHTINGER
Suffix:
Gender:M
Credentials:MSW/ LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 80209
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10308-0209
Mailing Address - Country:US
Mailing Address - Phone:718-667-1258
Mailing Address - Fax:718-667-1423
Practice Address - Street 1:31 1ST ST
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-2201
Practice Address - Country:US
Practice Address - Phone:718-667-1258
Practice Address - Fax:718-667-1423
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0553701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN1K981Medicare PIN