Provider Demographics
NPI:1538525852
Name:SCHRODER, LISA (BSL)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:
Last Name:SCHRODER
Suffix:
Gender:F
Credentials:BSL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3913 TRASK AVE
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16508-3135
Mailing Address - Country:US
Mailing Address - Phone:814-490-0720
Mailing Address - Fax:
Practice Address - Street 1:3913 TRASK AVE
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16508-3135
Practice Address - Country:US
Practice Address - Phone:814-490-0720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-04
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH002793103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst