Provider Demographics
NPI:1588365456
Name:SCHOSTAL, MONROE STREET (LP)
Entity type:Individual
Prefix:
First Name:MONROE
Middle Name:STREET
Last Name:SCHOSTAL
Suffix:
Gender:M
Credentials:LP
Other - Prefix:
Other - First Name:MONROE
Other - Middle Name:STREET
Other - Last Name:SCHOSTAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LP
Mailing Address - Street 1:698 CLASSON AVE APT 1A
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238-3742
Mailing Address - Country:US
Mailing Address - Phone:802-363-6818
Mailing Address - Fax:
Practice Address - Street 1:26 COURT ST STE 712
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11242-1107
Practice Address - Country:US
Practice Address - Phone:347-725-1269
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-16
Last Update Date:2024-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001171103TP0814X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis