Provider Demographics
NPI:1588657225
Name:SCHNEIDER, RAYMOND K (PHD)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:K
Last Name:SCHNEIDER
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 1:5530 NETHERLAND AVE
Mailing Address - Street 2:APT. 1 B
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10471-2361
Mailing Address - Country:US
Mailing Address - Phone:781-796-4788
Mailing Address - Fax:718-796-4788
Practice Address - Street 1:5530 NETHERLAND AVE
Practice Address - Street 2:APT. 1 B
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10471-2361
Practice Address - Country:US
Practice Address - Phone:781-796-4788
Practice Address - Fax:718-796-4788
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007424-0103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01404026Medicaid
NYV94411Medicare ID - Type UnspecifiedMEDICARE NO.
NY01404026Medicaid