Provider Demographics
NPI:1538167218
Name:SCHNEIDER, TED ALLAN (MA, CSW, LLP)
Entity type:Individual
Prefix:
First Name:TED
Middle Name:ALLAN
Last Name:SCHNEIDER
Suffix:
Gender:M
Credentials:MA, CSW, LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E MAPLE RD
Mailing Address - Street 2:STE 320
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-6308
Mailing Address - Country:US
Mailing Address - Phone:248-644-2900
Mailing Address - Fax:248-644-2902
Practice Address - Street 1:111 S OLD WOODWARD AVE
Practice Address - Street 2:STE 212A
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-6117
Practice Address - Country:US
Practice Address - Phone:248-644-2900
Practice Address - Fax:248-644-2902
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301002954103T00000X
MI6801820618104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No104100000XBehavioral Health & Social Service ProvidersSocial Worker