Healthcare Provider Details

I. General information

NPI: 1124110416
Provider Name (Legal Business Name): GEOFFREY C SCHILLER MSW, LICSW, CMHS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1107 PACIFIC HIGHWAY NORTH
LONG BEACH WA
98631
US

IV. Provider business mailing address

PO BOX 863
LONG BEACH WA
98631
US

V. Phone/Fax

Practice location:
  • Phone: 360-642-3787
  • Fax: 360-642-2096
Mailing address:
  • Phone: 360-642-6787
  • Fax: 360-642-2096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW00004751
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: