Healthcare Provider Details

I. General information

NPI: 1700979077
Provider Name (Legal Business Name): BRADLEY WAYNE SCHULTZ LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2006
Last Update Date: 03/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 MARION AVE SUITE 6
COLD SPRING NY
10516-2929
US

IV. Provider business mailing address

14 WILLIAM ST
FISHKILL NY
12524-2722
US

V. Phone/Fax

Practice location:
  • Phone: 646-415-8414
  • Fax: 646-290-6047
Mailing address:
  • Phone: 646-415-8414
  • Fax: 646-290-6047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR047052
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: