Healthcare Provider Details

I. General information

NPI: 1316906100
Provider Name (Legal Business Name): CAROLYN SCHNEIDERMAN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2006
Last Update Date: 02/19/2020
Certification Date: 02/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8007 LYNDON CENTRE WAY
LOUISVILLE KY
40222-3608
US

IV. Provider business mailing address

3405 ASCOT CIR
LOUISVILLE KY
40241-2505
US

V. Phone/Fax

Practice location:
  • Phone: 502-403-7768
  • Fax:
Mailing address:
  • Phone: 502-403-7768
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number5905
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1600
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: