Healthcare Provider Details

I. General information

NPI: 1679117766
Provider Name (Legal Business Name): JEFFREY H SCHNITZER BA M. ED ED.D. LSP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2019
Last Update Date: 10/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 CONCORD AVE
LEXINGTON MA
02421-8203
US

IV. Provider business mailing address

127 CONCORD AVE
LEXINGTON MA
02421-8203
US

V. Phone/Fax

Practice location:
  • Phone: 781-504-1374
  • Fax: 781-862-5666
Mailing address:
  • Phone: 781-504-1374
  • Fax: 781-862-5666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number253541
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: