Provider Demographics
NPI:1255523106
Name:SCHOENHOLTZ, PETER MARC (LCSW)
Entity type:Individual
Prefix:MR
First Name:PETER
Middle Name:MARC
Last Name:SCHOENHOLTZ
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:ROXBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06783-1717
Mailing Address - Country:US
Mailing Address - Phone:203-417-1654
Mailing Address - Fax:
Practice Address - Street 1:38 SOUTH ST
Practice Address - Street 2:
Practice Address - City:ROXBURY
Practice Address - State:CT
Practice Address - Zip Code:06783-1717
Practice Address - Country:US
Practice Address - Phone:203-417-1654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-14
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0014171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical