Provider Demographics
NPI:1144244260
Name:SCHROEDER, ERIC J (MSW)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:J
Last Name:SCHROEDER
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 CRAWFORD AVE
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13224-1712
Mailing Address - Country:US
Mailing Address - Phone:315-559-4236
Mailing Address - Fax:315-446-3791
Practice Address - Street 1:220 CRAWFORD AVE
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13224-1712
Practice Address - Country:US
Practice Address - Phone:314-559-4236
Practice Address - Fax:315-446-3791
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR018584-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY52419BMedicare ID - Type UnspecifiedPROVIDER NUMBER