Provider Demographics
NPI:1205130812
Name:SCHAFF, MICHAEL B (LCSW-R)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:B
Last Name:SCHAFF
Suffix:
Gender:M
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 WOOD ST
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-5531
Mailing Address - Country:US
Mailing Address - Phone:607-793-6382
Mailing Address - Fax:
Practice Address - Street 1:103 W SENECA ST
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-4157
Practice Address - Country:US
Practice Address - Phone:607-793-6382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-23
Last Update Date:2010-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR057945-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health