Provider Demographics
NPI:1790001048
Name:SCHROETER, JOSEPH (LADAC1)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:SCHROETER
Suffix:
Gender:M
Credentials:LADAC1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 BANGOR ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01118-2018
Mailing Address - Country:US
Mailing Address - Phone:413-301-5735
Mailing Address - Fax:
Practice Address - Street 1:53 BANGOR ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01118-2018
Practice Address - Country:US
Practice Address - Phone:413-301-5735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-12
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA410101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)