Provider Demographics
NPI:1164711404
Name:SCHNIZLER, LAURA J (LCSW)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:J
Last Name:SCHNIZLER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:941 B ST
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-4024
Mailing Address - Country:US
Mailing Address - Phone:707-347-6629
Mailing Address - Fax:707-769-9935
Practice Address - Street 1:941 B ST
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-4024
Practice Address - Country:US
Practice Address - Phone:707-347-6629
Practice Address - Fax:707-763-8127
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-06
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 271781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL680934100Medicaid