Provider Demographics
NPI:1164757878
Name:SCHREFFLER, MARK (PHD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:SCHREFFLER
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 1:545 W DEMELLO DR
Mailing Address - Street 2:
Mailing Address - City:TIVERTON
Mailing Address - State:RI
Mailing Address - Zip Code:02878-2772
Mailing Address - Country:US
Mailing Address - Phone:401-624-6249
Mailing Address - Fax:
Practice Address - Street 1:545 W DEMELLO DR
Practice Address - Street 2:
Practice Address - City:TIVERTON
Practice Address - State:RI
Practice Address - Zip Code:02878-2772
Practice Address - Country:US
Practice Address - Phone:401-624-6249
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-14
Last Update Date:2009-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPS00614103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist