Provider Demographics
NPI:1407049182
Name:SCHNEIDER, CHARLES ROBERT (LCSW, C-CATODSW)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:ROBERT
Last Name:SCHNEIDER
Suffix:
Gender:M
Credentials:LCSW, C-CATODSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 CHEVERUS RD
Mailing Address - Street 2:
Mailing Address - City:CAPE ELIZABETH
Mailing Address - State:ME
Mailing Address - Zip Code:04107-1237
Mailing Address - Country:US
Mailing Address - Phone:207-232-5620
Mailing Address - Fax:
Practice Address - Street 1:884 BROADWAY
Practice Address - Street 2:OFFICE NUMBER 2
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-4371
Practice Address - Country:US
Practice Address - Phone:207-232-5620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-24
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC73591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical