Provider Demographics
NPI:1063592202
Name:SCHREIBER, JONATHAN SCOTT (LMFT)
Entity type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:SCOTT
Last Name:SCHREIBER
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 COVENTRY RD
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD CENTER
Mailing Address - State:CT
Mailing Address - Zip Code:06250-1439
Mailing Address - Country:US
Mailing Address - Phone:860-931-5054
Mailing Address - Fax:888-502-4995
Practice Address - Street 1:147 COVENTRY RD
Practice Address - Street 2:
Practice Address - City:MANSFIELD CENTER
Practice Address - State:CT
Practice Address - Zip Code:06250-1439
Practice Address - Country:US
Practice Address - Phone:860-931-5054
Practice Address - Fax:888-502-4995
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2015-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001127106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTCTGA000438 B810006OtherSAGA
CTANC1482OtherOXFORD HEALTH PLAN
CTCTGA000438 B751773OtherSAGA
CT269952OtherMHN
CT004262408Medicaid