Healthcare Provider Details

I. General information

NPI: 1144974007
Provider Name (Legal Business Name): SHAWN JOSEPH SCHROEDER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2022
Last Update Date: 03/04/2022
Certification Date: 03/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7801 YORK RD STE 360
TOWSON MD
21204-7465
US

IV. Provider business mailing address

7801 YORK RD STE 360
TOWSON MD
21204-7465
US

V. Phone/Fax

Practice location:
  • Phone: 410-847-7171
  • Fax:
Mailing address:
  • Phone: 410-847-7171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: