Provider Demographics
NPI:1134137631
Name:SCHWARTZ, MICHAEL E (PSYD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:E
Last Name:SCHWARTZ
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 SULLIVAN AVE
Mailing Address - Street 2:SUITE 2-5
Mailing Address - City:FERNDALE
Mailing Address - State:NY
Mailing Address - Zip Code:12734-4315
Mailing Address - Country:US
Mailing Address - Phone:845-292-6222
Mailing Address - Fax:845-292-6220
Practice Address - Street 1:111 SULLIVAN AVE
Practice Address - Street 2:SUITE 2-5
Practice Address - City:FERNDALE
Practice Address - State:NY
Practice Address - Zip Code:12734-4315
Practice Address - Country:US
Practice Address - Phone:845-292-6222
Practice Address - Fax:845-292-6220
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY68-15434103G00000X, 103T00000X, 103TC0700X, 103TC2200X, 103TA0700X, 103TF0200X, 103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1039270OtherBEACON/HUDSON HEALTH
779700000OtherMAGELLAN
NY02621736Medicaid
7027655OtherAETNA
P3404576OtherOXFORD PROVIDER #
NY1039270OtherBEACON/HUDSON HEALTH