Provider Demographics
NPI:1053048256
Name:SCHWARTZ, LYNNE
Entity type:Individual
Prefix:
First Name:LYNNE
Middle Name:
Last Name:SCHWARTZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 SUMMER CIR
Mailing Address - Street 2:
Mailing Address - City:ELWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11731-4837
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:200 SUMMER CIR
Practice Address - Street 2:
Practice Address - City:ELWOOD
Practice Address - State:NY
Practice Address - Zip Code:11731-4837
Practice Address - Country:US
Practice Address - Phone:516-567-7262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-07
Last Update Date:2022-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0539611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000000OtherNA