Provider Demographics
NPI:1740816586
Name:SCHNEBLE, ELISA
Entity type:Individual
Prefix:
First Name:ELISA
Middle Name:
Last Name:SCHNEBLE
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 1:25 HAWKTON PL
Mailing Address - Street 2:
Mailing Address - City:LAKE GROVE
Mailing Address - State:NY
Mailing Address - Zip Code:11755-1903
Mailing Address - Country:US
Mailing Address - Phone:631-738-6738
Mailing Address - Fax:
Practice Address - Street 1:25 HAWKTON PL
Practice Address - Street 2:
Practice Address - City:LAKE GROVE
Practice Address - State:NY
Practice Address - Zip Code:11755-1903
Practice Address - Country:US
Practice Address - Phone:631-521-5653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-12
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY092471104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker