Healthcare Provider Details

I. General information

NPI: 1649960162
Provider Name (Legal Business Name): JANE SCHROEDER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2023
Last Update Date: 05/09/2023
Certification Date: 05/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BRADLEY RD
WOODBRIDGE CT
06525-2285
US

IV. Provider business mailing address

126 PARK AVE
BRIDGEPORT CT
06604-5692
US

V. Phone/Fax

Practice location:
  • Phone: 203-298-9005
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: