Healthcare Provider Details

I. General information

NPI: 1700798808
Provider Name (Legal Business Name): CARL C SCHAEFFER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: CASEY SCHAEFFER

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 VISTA CIRCLE DR
SIERRA MADRE CA
91024-1437
US

IV. Provider business mailing address

18 VISTA CIRCLE DR
SIERRA MADRE CA
91024-1437
US

V. Phone/Fax

Practice location:
  • Phone: 626-696-0092
  • Fax:
Mailing address:
  • Phone: 626-696-0092
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: