Provider Demographics
NPI:1609385830
Name:SCHWARTZ, ROGER MAX
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:MAX
Last Name:SCHWARTZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:843 4TH ST APT 207
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-1208
Mailing Address - Country:US
Mailing Address - Phone:310-600-6840
Mailing Address - Fax:
Practice Address - Street 1:843 4TH ST APT 207
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-1208
Practice Address - Country:US
Practice Address - Phone:310-600-6840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-20
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA123207106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist