Provider Demographics
NPI:1417909912
Name:SCHROEDER, JAMES P (LCSW)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:P
Last Name:SCHROEDER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 PROFESSIONAL BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47714-8018
Mailing Address - Country:US
Mailing Address - Phone:812-477-7246
Mailing Address - Fax:812-477-7240
Practice Address - Street 1:2330 LYNCH RD STE 100
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47711-2998
Practice Address - Country:US
Practice Address - Phone:812-477-7246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN35000337A106H00000X
IN34000743A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000363386OtherANTHEM
IN673579OtherHEALTHLINK
IN000000363386OtherANTHEM
IN010056774Medicare PIN
INS25736Medicare UPIN