Provider Demographics
NPI:1376548867
Name:SCHNIRMAN, GEOFFREY M (PHD)
Entity Type:Individual
Prefix:DR
First Name:GEOFFREY
Middle Name:M
Last Name:SCHNIRMAN
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 1:100 PERKINS FARM DRIVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MYSTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06355
Mailing Address - Country:US
Mailing Address - Phone:401-486-4374
Mailing Address - Fax:
Practice Address - Street 1:100 PERKINS FARM DR STE 102
Practice Address - Street 2:
Practice Address - City:MYSTIC
Practice Address - State:CT
Practice Address - Zip Code:06355-4041
Practice Address - Country:US
Practice Address - Phone:860-870-6385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPS00813103G00000X, 103TC0700X
CT103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI26685-1OtherRI BCBS PROVIDER ID
CT003971OtherCT LIC
RI411522OtherBLUE CHIP PROVIDER ID