Provider Demographics
NPI:1780717447
Name:SCHAEFER, BIANCA MARIA (PHD)
Entity type:Individual
Prefix:DR
First Name:BIANCA
Middle Name:MARIA
Last Name:SCHAEFER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 FEATHERWOOD CT
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12303-5704
Mailing Address - Country:US
Mailing Address - Phone:515-428-6061
Mailing Address - Fax:518-356-1834
Practice Address - Street 1:526 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-5544
Practice Address - Country:US
Practice Address - Phone:518-587-4161
Practice Address - Fax:518-587-5134
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015972-1103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0004100050001OtherPAYEE ID (BSNENY)