Provider Demographics
NPI:1194153734
Name:SCHNEIDER, STACIE (MA/CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:STACIE
Middle Name:
Last Name:SCHNEIDER
Suffix:
Gender:F
Credentials:MA/CCC-SLP
Other - Prefix:MS
Other - First Name:STACIE
Other - Middle Name:
Other - Last Name:GOLDENBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA/CCC-SLP
Mailing Address - Street 1:30 WESTWOOD DR APT 58
Mailing Address - Street 2:
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-1607
Mailing Address - Country:US
Mailing Address - Phone:516-801-5100
Mailing Address - Fax:
Practice Address - Street 1:3 GLEN COVE RD
Practice Address - Street 2:
Practice Address - City:GREENVALE
Practice Address - State:NY
Practice Address - Zip Code:11548-1323
Practice Address - Country:US
Practice Address - Phone:516-801-5400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-16
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009480-1251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01382067Medicaid