Provider Demographics
NPI:1063546059
Name:SCHWALBERG, MICHAEL DAVID (PHD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DAVID
Last Name:SCHWALBERG
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:159 GREEN ST.
Mailing Address - Street 2:SUITE 1
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-3737
Mailing Address - Country:US
Mailing Address - Phone:845-339-2352
Mailing Address - Fax:845-339-2382
Practice Address - Street 1:159 GREEN ST.
Practice Address - Street 2:SUITE 1
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-3737
Practice Address - Country:US
Practice Address - Phone:845-339-2352
Practice Address - Fax:845-339-2382
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2008-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010814103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY047646OtherVALUEOPTIONS
NY01272095Medicaid
NY317761OtherMVP HEALTHCARE
NYV72012Medicare ID - Type Unspecified