Provider Demographics
NPI:1063468874
Name:SCHNEIDER, MARC A (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:A
Last Name:SCHNEIDER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:DR
Other - First Name:MARC
Other - Middle Name:
Other - Last Name:SCHNEIDER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:1341 WARREN AVE
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-3437
Mailing Address - Country:US
Mailing Address - Phone:630-719-5454
Mailing Address - Fax:630-719-1263
Practice Address - Street 1:1341 WARREN AVE
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-3437
Practice Address - Country:US
Practice Address - Phone:630-719-5454
Practice Address - Fax:630-719-1263
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2011-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-003737103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK26949Medicare ID - Type Unspecified
ILS44839Medicare UPIN