Provider Demographics
NPI:1659414985
Name:SCHROEDER, GERALD L (PHD)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:L
Last Name:SCHROEDER
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 1:2323 DE LA VINA ST
Mailing Address - Street 2:301
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93105-3877
Mailing Address - Country:US
Mailing Address - Phone:805-682-1866
Mailing Address - Fax:805-682-1866
Practice Address - Street 1:2323 DE LA VINA ST
Practice Address - Street 2:301
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-3877
Practice Address - Country:US
Practice Address - Phone:805-682-1866
Practice Address - Fax:805-682-1866
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY4465103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP4465Medicare ID - Type Unspecified