Provider Demographics
NPI:1972944098
Name:CHASE-SCHUMAN, BETH (PHD)
Entity Type:Individual
Prefix:DR
First Name:BETH
Middle Name:
Last Name:CHASE-SCHUMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:JILLIAN
Other - Last Name:CHASE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:82 TURKEY LN
Mailing Address - Street 2:
Mailing Address - City:COLD SPRING HARBOR
Mailing Address - State:NY
Mailing Address - Zip Code:11724-1703
Mailing Address - Country:US
Mailing Address - Phone:631-367-6992
Mailing Address - Fax:
Practice Address - Street 1:82 TURKEY LN
Practice Address - Street 2:
Practice Address - City:COLD SPRING HARBOR
Practice Address - State:NY
Practice Address - Zip Code:11724-1703
Practice Address - Country:US
Practice Address - Phone:631-367-6992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-17
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019984-1103TC2200X, 103T00000X
NY1214181103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool