Provider Demographics
NPI:1851507230
Name:SCHWARZCHILD, MICHAEL
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:SCHWARZCHILD
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 1:36 MILL PLAIN RD
Mailing Address - Street 2:SUITE 306
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06811-5181
Mailing Address - Country:US
Mailing Address - Phone:203-778-8105
Mailing Address - Fax:203-778-8105
Practice Address - Street 1:36 MILL PLAIN RD
Practice Address - Street 2:SUITE 306
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06811-5181
Practice Address - Country:US
Practice Address - Phone:203-778-8105
Practice Address - Fax:203-778-8105
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001598103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT060001598CT02OtherANTHEM BC/BS
CT060001598CT02OtherANTHEM BC/BS