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General NPI Number Information
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NPI Number | 1659046464
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Entity Type | Individual
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Provider Name | KAITLYN MARIE SCHNEIDER PHD
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Gender | Female
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Dates
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Enumeration Date | 08/13/2021
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Last Update Date | 06/06/2024
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Provider Practice Location Address
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Address Line | 729 BOYLSTON ST FL 5
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City | BOSTON
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State | MA
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Zip | 02116-2639
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Country | US
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Telephone | 617-800-9610
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Fax |
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Provider Business Mailing Address
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Address Line | 11 COPPER BROOK CIR
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City | GRANBY
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State | CT
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Zip | 06035-2436
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Country | US
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Telephone | 860-605-4180
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 10000109
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License Number State | MA
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