Healthcare Provider Details

I. General information

NPI: 1548599160
Provider Name (Legal Business Name): JEFFREY JAMES SCHNEIDER PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2009
Last Update Date: 03/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 BEE ST COMPENSATION AND PENSION
CHARLESTON SC
29401-5703
US

IV. Provider business mailing address

109 BEE ST COMPENSATION AND PENSION
CHARLESTON SC
29401-5703
US

V. Phone/Fax

Practice location:
  • Phone: 843-577-5011
  • Fax:
Mailing address:
  • Phone: 843-577-5011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPSY003812
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY003812
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: