Provider Demographics
NPI:1952703456
Name:MARK J. SCHILLER, M.D., PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:MARK J. SCHILLER, M.D., PROFESSIONAL CORPORATION
Other - Org Name:MIND THERAPY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:J
Authorized Official - Last Name:SCHILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-945-9870
Mailing Address - Street 1:150 NELLEN AVE
Mailing Address - Street 2:STE. 100
Mailing Address - City:CORTE MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:94925-1104
Mailing Address - Country:US
Mailing Address - Phone:415-945-9870
Mailing Address - Fax:415-945-9325
Practice Address - Street 1:150 NELLEN AVE
Practice Address - Street 2:STE. 100
Practice Address - City:CORTE MADERA
Practice Address - State:CA
Practice Address - Zip Code:94925-1104
Practice Address - Country:US
Practice Address - Phone:415-945-9870
Practice Address - Fax:415-945-9325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-16
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG765192084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty