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General NPI Number Information
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NPI Number | 1457394082
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Entity Type | Individual
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Provider Name | CONSTANCE ELLEN SCHOENBERG PH.D.
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Gender | Female
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Dates
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Enumeration Date | 06/13/2006
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Last Update Date | 02/26/2014
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Provider Practice Location Address
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Address Line | 1239 N COUNTRY RD STE 7
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City | STONY BROOK
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State | NY
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Zip | 11790-1934
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Country | US
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Telephone | 631-751-4615
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Fax | 631-941-2774
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Provider Business Mailing Address
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Address Line | 201 E BROADWAY
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City | PORT JEFFERSON
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State | NY
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Zip | 11777-1248
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Country | US
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Telephone | 631-928-5245
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Fax | 631-941-2774
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 011324
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License Number State | NY
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