=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255041562
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ELI SCHWARTZ LMSW
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/28/2022
-----------------------------------------------------
Last Update Date | 11/28/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 42 MELNICK DR
-----------------------------------------------------
City | MONSEY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10952-3328
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-855-5576
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5 HILLWOOD CT
-----------------------------------------------------
City | THIELLS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10984-1414
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-855-5576
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 117711-01
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------