Provider Demographics
NPI:1700979077
Name:SCHULTZ, BRADLEY WAYNE (LCSW)
Entity Type:Individual
Prefix:MR
First Name:BRADLEY
Middle Name:WAYNE
Last Name:SCHULTZ
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 WILLIAM ST
Mailing Address - Street 2:
Mailing Address - City:FISHKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12524-2722
Mailing Address - Country:US
Mailing Address - Phone:646-415-8414
Mailing Address - Fax:646-290-6047
Practice Address - Street 1:8 MARION AVE
Practice Address - Street 2:SUITE 6
Practice Address - City:COLD SPRING
Practice Address - State:NY
Practice Address - Zip Code:10516-2929
Practice Address - Country:US
Practice Address - Phone:646-415-8414
Practice Address - Fax:646-290-6047
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-01
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0470521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN7M741Medicare ID - Type UnspecifiedMEDICARE PART B
NYN7M741Medicare PIN