Provider Demographics
NPI:1053498055
Name:SCHRAUB, CHARLES W (LCSW)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:W
Last Name:SCHRAUB
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26805 FOGGY MEADOWS ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78260-2218
Mailing Address - Country:US
Mailing Address - Phone:830-980-2649
Mailing Address - Fax:830-980-2559
Practice Address - Street 1:19206 HUEBNER RD
Practice Address - Street 2:SUITE 104
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3146
Practice Address - Country:US
Practice Address - Phone:210-499-1020
Practice Address - Fax:210-499-4956
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX168281041C0700X
TX3298106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX060848OtherVALUE OPTIONS
TX190131000OtherMAGELLAN
TX742675485004OtherTRICARE SOUTH REGION
TX00S41SMedicare ID - Type Unspecified