Healthcare Provider Details

I. General information

NPI: 1821000894
Provider Name (Legal Business Name): JULIE CANTOR SCHUCK LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6729 MYRTLE AVE
GLENDALE NY
11385-7063
US

IV. Provider business mailing address

81 S 6TH ST APT. 2
BROOKLYN NY
11211-6026
US

V. Phone/Fax

Practice location:
  • Phone: 718-456-7001
  • Fax: 718-456-9470
Mailing address:
  • Phone: 917-974-2814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number069302
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: