Provider Demographics
NPI:1013238583
Name:SCHNEIDER, KIMBERLEE (LMSW)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLEE
Middle Name:
Last Name:SCHNEIDER
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 1:74 COLD BROOK ST.
Mailing Address - Street 2:
Mailing Address - City:POLAND
Mailing Address - State:NY
Mailing Address - Zip Code:13431
Mailing Address - Country:US
Mailing Address - Phone:315-826-0219
Mailing Address - Fax:
Practice Address - Street 1:74 COLD BROOK ST.
Practice Address - Street 2:
Practice Address - City:POLAND
Practice Address - State:NY
Practice Address - Zip Code:13431
Practice Address - Country:US
Practice Address - Phone:315-826-0219
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-18
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY094375-1104100000X
NY9653721511041S0200X
NY12654172355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant