Provider Demographics
NPI:1356936371
Name:SCHAEFER, HALLIE NICOLE
Entity type:Individual
Prefix:
First Name:HALLIE
Middle Name:NICOLE
Last Name:SCHAEFER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 FOSTER RD
Mailing Address - Street 2:
Mailing Address - City:LAKE RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-4339
Mailing Address - Country:US
Mailing Address - Phone:631-352-6382
Mailing Address - Fax:
Practice Address - Street 1:88 FOSTER RD
Practice Address - Street 2:
Practice Address - City:LAKE RONKONKOMA
Practice Address - State:NY
Practice Address - Zip Code:11779-4339
Practice Address - Country:US
Practice Address - Phone:631-352-6382
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-02
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician