Provider Demographics
NPI:1831208644
Name:SCHNEIDER, STANLEY (LIC PSYCHOLOGIST)
Entity type:Individual
Prefix:
First Name:STANLEY
Middle Name:
Last Name:SCHNEIDER
Suffix:
Gender:M
Credentials:LIC PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 ERFORD RD
Mailing Address - Street 2:
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011-1117
Mailing Address - Country:US
Mailing Address - Phone:717-732-2917
Mailing Address - Fax:717-732-5375
Practice Address - Street 1:412 ERFORD RD
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-1117
Practice Address - Country:US
Practice Address - Phone:717-732-2917
Practice Address - Fax:717-732-5375
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS000272L103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA029474MVSMedicare PIN