Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | R043885 | NY |
Y | 1041C0700X | Clinical Social Worker | LC18002 | ME |
NPI | 1003078775 |
---|---|
Provider Name | Ms. Ilene Julie Schneider |
First Address | Carmel, NY 10512-2356 |
Second Address | Ellsworth, ME 04605 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2008 |
Last Update Date | 06/08/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
R043885 | LICENSE (01) | NY |