MEDICARE: MS. LISA SCHNALL LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	R047460-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0127448	OTHER	NY	GHI INSURANCE

General Provider Information

NPI Number	:	1285835470
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LISA SCHNALL LCSW

Provider Business Mailing Address
First Line	:	250 W 104TH ST
Second Line	:	#44
City	:	NEW YORK
State	:	NY
Zip	:	10025-4220
Country	:	US
Telephone Number	:	212-969-0889
Fax Number	:

Provider Business Practice Location Address
First Line	:	240 W 102ND ST
Second Line	:	SUITE 15
City	:	NEW YORK
State	:	NY
Zip	:	10025-4900
Country	:	US
Telephone Number	:	212-969-0889
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/29/2007
Last Update Date	:	07/08/2007

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