Provider Demographics
NPI:1114093093
Name:SCHROER, THOMAS ANTHONY (PHD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:ANTHONY
Last Name:SCHROER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5112 OLD DUBLIN CT
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45415-3171
Mailing Address - Country:US
Mailing Address - Phone:937-572-6005
Mailing Address - Fax:
Practice Address - Street 1:409 E MONUMENT AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45402-1260
Practice Address - Country:US
Practice Address - Phone:937-208-7084
Practice Address - Fax:937-208-7088
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPL3400103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHSCCP75941Medicare ID - Type UnspecifiedPSYCHOLOGIST