Healthcare Provider Details

I. General information

NPI: 1386094092
Provider Name (Legal Business Name): SYLVAN SCHNEIDER LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2016
Last Update Date: 06/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2088 PASEO PRIMERO APT1
SANTA FE NM
87501-8398
US

IV. Provider business mailing address

2088 PASEO PRIMERO APT1
SANTA FE NM
87501-8398
US

V. Phone/Fax

Practice location:
  • Phone: 443-745-5880
  • Fax:
Mailing address:
  • Phone: 443-745-5880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number0181141
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: