Provider Demographics
NPI:1598030058
Name:SCHRADER, LISA (MS ED, BCBA)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:SCHRADER
Suffix:
Gender:F
Credentials:MS ED, BCBA
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:FREELAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19019 VENTURA BLVD
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-3253
Mailing Address - Country:US
Mailing Address - Phone:818-345-2345
Mailing Address - Fax:866-587-2383
Practice Address - Street 1:6 N MAIN ST
Practice Address - Street 2:STE 110
Practice Address - City:FAIRPORT
Practice Address - State:NY
Practice Address - Zip Code:14450-1524
Practice Address - Country:US
Practice Address - Phone:585-377-6590
Practice Address - Fax:585-377-6605
Is Sole Proprietor?:No
Enumeration Date:2012-03-16
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-07-3924103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst