1154518702 NPI number — MR. MATTHEW DAVID EDWARD SCHNEIDER LCSW-C

Table of content: MR. MATTHEW DAVID EDWARD SCHNEIDER LCSW-C (NPI 1154518702)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154518702 NPI number — MR. MATTHEW DAVID EDWARD SCHNEIDER LCSW-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHNEIDER
Provider First Name:
MATTHEW
Provider Middle Name:
DAVID EDWARD
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LCSW-C
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154518702
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/08/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 67
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RAILROAD
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17355-0067
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-507-6630
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
27 N MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHREWSBURY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17361-1321
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-507-6630
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  15669 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 522156095 . This is a "COMMERCIAL" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 522156095 . This is a "MHNET" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 522156095 . This is a "AMERICAN PSYCH SYSTEM" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 609550002 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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