Provider Demographics
NPI:1689128159
Name:SCHWADERER, NATESHA (LCADC)
Entity Type:Individual
Prefix:MRS
First Name:NATESHA
Middle Name:
Last Name:SCHWADERER
Suffix:
Gender:F
Credentials:LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 CIRCLE DRIVE
Mailing Address - Street 2:
Mailing Address - City:CROWNSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21032-2061
Mailing Address - Country:US
Mailing Address - Phone:443-598-6900
Mailing Address - Fax:410-923-6781
Practice Address - Street 1:107 CIRCLE DRIVE
Practice Address - Street 2:
Practice Address - City:CROWNSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21032-2061
Practice Address - Country:US
Practice Address - Phone:443-598-6900
Practice Address - Fax:410-923-6781
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-12
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCA2295101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1851838643Medicaid