Provider Demographics
NPI:1134965411
Name:SCHADER, CORRINA (MA PPS LEP)
Entity type:Individual
Prefix:
First Name:CORRINA
Middle Name:
Last Name:SCHADER
Suffix:
Gender:F
Credentials:MA PPS LEP
Other - Prefix:
Other - First Name:CORRINA
Other - Middle Name:
Other - Last Name:LICON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1160 E PERRIN AVE APT 271
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-4283
Mailing Address - Country:US
Mailing Address - Phone:559-696-3231
Mailing Address - Fax:
Practice Address - Street 1:1160 E PERRIN AVE APT 271
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-4283
Practice Address - Country:US
Practice Address - Phone:559-696-3231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-05
Last Update Date:2024-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4240103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool