Healthcare Provider Details

I. General information

NPI: 1265989628
Provider Name (Legal Business Name): CHARLES SCHAEFFER PH.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2016
Last Update Date: 09/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 WASHINGTON SQ W SUITE 5R
NEW YORK NY
10011-9126
US

IV. Provider business mailing address

315 8TH AVE APT 17
BROOKLYN NY
11215-6621
US

V. Phone/Fax

Practice location:
  • Phone: 718-577-1564
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number021761
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number021761
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number021761
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: