MEDICARE: MR. WILLIAM MARTIN SCHROEDER

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
1	101Y00000X	Counselor
2	101YM0800X	Mental Health Counselor
3	106H00000X	Marriage & Family Therapist	IMF67934	CA

General Provider Information

NPI Number	:	1780867325
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WILLIAM MARTIN SCHROEDER

Provider Business Mailing Address
First Line	:	1100 GOODMAN ST S STE 118
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14620-2530
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1100 GOODMAN ST S STE 118
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14620-2530
Country	:	US
Telephone Number	:	585-604-9618
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/05/2007
Last Update Date	:	05/25/2023

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