Provider Demographics
NPI:1609496355
Name:KLEIN SCHNEIDER, LISA ROBIN (LCSW)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:ROBIN
Last Name:KLEIN SCHNEIDER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20614 LORI DR APT 3
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11360-1496
Mailing Address - Country:US
Mailing Address - Phone:917-445-4834
Mailing Address - Fax:
Practice Address - Street 1:206-14 LORI DRIVE,FLOOR 3
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11360-1136
Practice Address - Country:US
Practice Address - Phone:917-445-4834
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-23
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY085788-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty