Healthcare Provider Details

I. General information

NPI: 1134137631
Provider Name (Legal Business Name): MICHAEL E SCHWARTZ PSYD.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 02/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 SULLIVAN AVE SUITE 2-5
FERNDALE NY
12734-4315
US

IV. Provider business mailing address

111 SULLIVAN AVE SUITE 2-5
FERNDALE NY
12734-4315
US

V. Phone/Fax

Practice location:
  • Phone: 845-292-6222
  • Fax: 845-292-6220
Mailing address:
  • Phone: 845-292-6222
  • Fax: 845-292-6220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number68-15434
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number68-15434
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number68-15434
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number68-15434
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number68-15434
License Number StateNY
# 6
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number68-15434
License Number StateNY
# 7
Primary TaxonomyN
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number68-15434
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: