Provider Demographics
NPI:1336609825
Name:SCHWARTZ, LAURIE FAYE (MS)
Entity Type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:FAYE
Last Name:SCHWARTZ
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MS
Other - First Name:LAURIE
Other - Middle Name:FAYE
Other - Last Name:SCHWARTZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS
Mailing Address - Street 1:20 W 64TH ST APT 21A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-7149
Mailing Address - Country:US
Mailing Address - Phone:212-496-1727
Mailing Address - Fax:212-496-1727
Practice Address - Street 1:20 W 64 ST
Practice Address - Street 2:APT 21A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023
Practice Address - Country:US
Practice Address - Phone:212-496-1727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-21
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003884-1103TC1900X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty