=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639352982
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | M & D SCHWAB, CSW-R, PSYCHOTHERAPY PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/10/2007
-----------------------------------------------------
Last Update Date | 06/02/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2000 WINTON RD S BUILDING 4, SUITE 100
-----------------------------------------------------
City | ROCHESTER
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14618-3970
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-241-3090
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2000 WINTON RD S BUILDING 4, SUITE 100
-----------------------------------------------------
City | ROCHESTER
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14618-3970
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MARIANNA SCHWAB
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 585-241-3090
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | R26081-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------