Provider Demographics
NPI:1538586300
Name:SCHROEDER, MARY MARVIN (PHD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:MARVIN
Last Name:SCHROEDER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:481 MAIN ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-6324
Mailing Address - Country:US
Mailing Address - Phone:914-473-1447
Mailing Address - Fax:
Practice Address - Street 1:481 MAIN ST
Practice Address - Street 2:SUITE 500
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-6324
Practice Address - Country:US
Practice Address - Phone:914-473-1447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-18
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY12177103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical