Provider Demographics
NPI:1609815778
Name:SCHROEDER, PETER STEPHEN (LCSW)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:STEPHEN
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 1:1800 MICHAEL FARADAY DR
Mailing Address - Street 2:SUITE 206
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-5354
Mailing Address - Country:US
Mailing Address - Phone:703-862-7861
Mailing Address - Fax:703-757-0341
Practice Address - Street 1:1800 MICHAEL FARADAY DR
Practice Address - Street 2:SUITE 206
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-5354
Practice Address - Country:US
Practice Address - Phone:703-862-7861
Practice Address - Fax:703-757-0341
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904003867101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA8913811Medicaid
VAPV165120OtherKAISER
VA61840017OtherFEDERAL BCBS
VA285132OtherANTHEM BCBS
VAS7881OtherAPS HEALTHCARE
VA7526040OtherAETNA HEALTHCARE