Provider Demographics
NPI:1922749407
Name:SCHADER, MONIQUE RENAY
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:RENAY
Last Name:SCHADER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2975 TREAT BLVD STE C5
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94518-3631
Mailing Address - Country:US
Mailing Address - Phone:925-219-9009
Mailing Address - Fax:
Practice Address - Street 1:2975 TREAT BLVD STE C5
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94518-3631
Practice Address - Country:US
Practice Address - Phone:925-219-9009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-06
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA172V00000X
CAMPSS-IOBRAG175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No172V00000XOther Service ProvidersCommunity Health Worker