Provider Demographics
NPI:1003028937
Name:SCHNEIDER, JUDITH SANDRA (LISW)
Entity Type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:SANDRA
Last Name:SCHNEIDER
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21074A HIGHWAY 84
Mailing Address - Street 2:
Mailing Address - City:ABIQUIU
Mailing Address - State:NM
Mailing Address - Zip Code:87510-0618
Mailing Address - Country:US
Mailing Address - Phone:505-685-0596
Mailing Address - Fax:505-685-0596
Practice Address - Street 1:21074A HIGHWAY 84
Practice Address - Street 2:
Practice Address - City:ABIQUIU
Practice Address - State:NM
Practice Address - Zip Code:87510-0618
Practice Address - Country:US
Practice Address - Phone:505-685-0596
Practice Address - Fax:505-685-0596
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-064541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical