Provider Demographics
NPI:1154397081
Name:SCHNEIDER, ROBERT BLACK (PSYD)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:BLACK
Last Name:SCHNEIDER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10633 GRISSOM AVE
Mailing Address - Street 2:
Mailing Address - City:MATHER
Mailing Address - State:CA
Mailing Address - Zip Code:95655-4123
Mailing Address - Country:US
Mailing Address - Phone:916-366-5449
Mailing Address - Fax:
Practice Address - Street 1:10633 GRISSOM AVE
Practice Address - Street 2:
Practice Address - City:MATHER
Practice Address - State:CA
Practice Address - Zip Code:95655-4123
Practice Address - Country:US
Practice Address - Phone:916-366-5449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPENDING103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical