MEDICARE: DR. GEOFFREY M SCHNIRMAN 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	103G00000X	Clinical Neuropsychologist	PS00813	RI
2	103TC0700X	Clinical Psychologist	PS00813	RI
3	103G00000X	Clinical Neuropsychologist		CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	26685-1	OTHER	RI	RI BCBS PROVIDER ID
2	003971	OTHER	CT	CT LIC
3	411522	OTHER	RI	BLUE CHIP PROVIDER ID

General Provider Information

NPI Number	:	1376548867
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GEOFFREY M SCHNIRMAN PHD

Provider Business Mailing Address
First Line	:	100 PERKINS FARM DRIVE
Second Line	:	SUITE 102
City	:	MYSTIC
State	:	CT
Zip	:	06355
Country	:	US
Telephone Number	:	401-486-4374
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 PERKINS FARM DR STE 102
Second Line	:
City	:	MYSTIC
State	:	CT
Zip	:	06355-4041
Country	:	US
Telephone Number	:	860-870-6385
Fax Number	:

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

Provider Enumeration Date	:	06/20/2005
Last Update Date	:	07/19/2022

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