Provider Demographics
NPI:1093852998
Name:SCHROEDER, MARION HOWARD (LISW)
Entity Type:Individual
Prefix:MRS
First Name:MARION
Middle Name:HOWARD
Last Name:SCHROEDER
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 1:5610 DONA ANA LOOP NE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87144-5207
Mailing Address - Country:US
Mailing Address - Phone:505-771-3404
Mailing Address - Fax:
Practice Address - Street 1:1001 23RD AVE NE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87144-7560
Practice Address - Country:US
Practice Address - Phone:505-896-3378
Practice Address - Fax:505-897-3387
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-34661041C0700X, 1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool