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NPI Code Detail

MEDICARE: BRENT SCHRADER LCSW

MEDICARE: BRENT SCHRADER LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerC-08687NM

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1114952033
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRENT SCHRADER LCSW
Provider Business Mailing Address
First Line : 1900 WESTRIDGE RD
Second Line :
City : CARLSBAD
State : NM
Zip : 88220-3550
Country : US
Telephone Number : 575-725-5552
Fax Number :
Provider Business Practice Location Address
First Line : 1900 WESTRIDGE RD
Second Line :
City : CARLSBAD
State : NM
Zip : 88220-3550
Country : US
Telephone Number : 575-725-5552
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/11/2006
Last Update Date : 01/11/2022

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Directions to “ BRENT SCHRADER LCSW” Practice Location

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