1811266141 NPI number — MISS LISA L SCHULZ LCSW-R

Table of content: MISS LISA L SCHULZ LCSW-R (NPI 1811266141)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811266141 NPI number — MISS LISA L SCHULZ LCSW-R

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHULZ
Provider First Name:
LISA
Provider Middle Name:
L
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
LCSW-R
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1811266141
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/22/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5 COURT ST STE 42
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORWICH
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13815-1695
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
607-337-1600
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1121 UPPER FRONT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BINGHAMTON
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13905-1116
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
607-297-8720
Provider Business Practice Location Address Fax Number:
607-204-0632
Provider Enumeration Date:
12/15/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  085261 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1811266141 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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