MEDICARE: DR. ED SCHMOOKLER PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PSY8597	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114131398
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ED SCHMOOKLER PHD

Provider Business Mailing Address
First Line	:	1350 SOLANO AVE
Second Line	:	UNIT A
City	:	ALBANY
State	:	CA
Zip	:	94706-1853
Country	:	US
Telephone Number	:	510-524-3654
Fax Number	:

Provider Business Practice Location Address
First Line	:	1350 SOLANO AVE
Second Line	:	UNIT A
City	:	ALBANY
State	:	CA
Zip	:	94706-1853
Country	:	US
Telephone Number	:	510-524-3654
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/09/2007
Last Update Date	:	09/07/2018

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