Provider Demographics
NPI:1528101136
Name:SCHORN, CHRISTA J (LCSW)
Entity type:Individual
Prefix:
First Name:CHRISTA
Middle Name:J
Last Name:SCHORN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CHRISTA
Other - Middle Name:J
Other - Last Name:STAEUBLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:63 TOMPKINS ST
Mailing Address - Street 2:
Mailing Address - City:EAST NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731-1043
Mailing Address - Country:US
Mailing Address - Phone:631-754-6054
Mailing Address - Fax:
Practice Address - Street 1:63 TOMPKINS ST
Practice Address - Street 2:
Practice Address - City:EAST NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11731-1043
Practice Address - Country:US
Practice Address - Phone:631-754-6054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRP0437201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical