Provider Demographics
NPI:1255492724
Name:SCHAEFER, MARK (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:SCHAEFER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
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Mailing Address - Street 1:1 SALEM GRN
Mailing Address - Street 2:SUITE 501
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-3724
Mailing Address - Country:US
Mailing Address - Phone:978-740-3100
Mailing Address - Fax:978-740-5656
Practice Address - Street 1:1 SALEM GRN
Practice Address - Street 2:SUITE 501
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-3724
Practice Address - Country:US
Practice Address - Phone:978-740-3100
Practice Address - Fax:978-740-5656
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA1977103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic