Provider Demographics
NPI:1952658395
Name:SCHLOSS, ROBERTA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ROBERTA
Middle Name:
Last Name:SCHLOSS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 KENNETH RD
Mailing Address - Street 2:
Mailing Address - City:HARTSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10530-2921
Mailing Address - Country:US
Mailing Address - Phone:914-275-1136
Mailing Address - Fax:914-674-4368
Practice Address - Street 1:12 KENNETH RD
Practice Address - Street 2:
Practice Address - City:HARTSDALE
Practice Address - State:NY
Practice Address - Zip Code:10530-2921
Practice Address - Country:US
Practice Address - Phone:914-275-1136
Practice Address - Fax:914-674-4368
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-03
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0199111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical