Provider Demographics
NPI:1851411268
Name:SCHUTZ, SAMUEL R
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:R
Last Name:SCHUTZ
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 1:25 BERRYWOOD LN
Mailing Address - Street 2:
Mailing Address - City:SOUTH HAMILTON
Mailing Address - State:MA
Mailing Address - Zip Code:01982-1503
Mailing Address - Country:US
Mailing Address - Phone:978-468-2063
Mailing Address - Fax:
Practice Address - Street 1:2 N MAIN ST STE 4
Practice Address - Street 2:
Practice Address - City:IPSWICH
Practice Address - State:MA
Practice Address - Zip Code:01938-2215
Practice Address - Country:US
Practice Address - Phone:978-356-0544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA14103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA043352830OtherFEDERAL TAX ID NUMBER