Healthcare Provider Details

I. General information

NPI: 1306193487
Provider Name (Legal Business Name): LYNNE E. SCHWARTZ PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2012
Last Update Date: 08/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 W 110TH ST
NEW YORK NY
10025-2422
US

IV. Provider business mailing address

401 W 110TH ST
NEW YORK NY
10025-2422
US

V. Phone/Fax

Practice location:
  • Phone: 646-707-3356
  • Fax:
Mailing address:
  • Phone: 646-707-3356
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number010252-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number010252-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number010252-1
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number010252-1
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number010252-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: