Healthcare Provider Details

I. General information

NPI: 1417909912
Provider Name (Legal Business Name): JAMES P SCHROEDER LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 02/23/2021
Certification Date: 02/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2330 LYNCH RD STE 100
EVANSVILLE IN
47711-2998
US

IV. Provider business mailing address

1101 PROFESSIONAL BLVD STE 100
EVANSVILLE IN
47714-8018
US

V. Phone/Fax

Practice location:
  • Phone: 812-477-7246
  • Fax:
Mailing address:
  • Phone: 812-477-7246
  • Fax: 812-477-7240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number35000337A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34000743A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: