Healthcare Provider Details

I. General information

NPI: 1437218971
Provider Name (Legal Business Name): STEPHEN SCHOENBROT LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 E MAIN ST SUITE 214
PATCHOGUE NY
11772-3121
US

IV. Provider business mailing address

43 COLBY DR
DIX HILLS NY
11746-8352
US

V. Phone/Fax

Practice location:
  • Phone: 631-486-2868
  • Fax: 631-858-0237
Mailing address:
  • Phone: 631-486-2868
  • Fax: 631-858-0237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberPR019914-1
License Number StateNY

VII. Legacy identifiers

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

# 1
Identifier0020953
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerGHI
# 2
IdentifierP1011059
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerOXFORD
# 3
Identifier060568
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerVALUE OPTIONS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: