Provider Demographics
NPI:1215337423
Name:SCHNITZLER, CHANNA (LPC)
Entity type:Individual
Prefix:
First Name:CHANNA
Middle Name:
Last Name:SCHNITZLER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 BLUERIDGE DRIVE EXT
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06704-6122
Mailing Address - Country:US
Mailing Address - Phone:917-880-2675
Mailing Address - Fax:
Practice Address - Street 1:104 BLUERIDGE DRIVE EXT
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06704-6122
Practice Address - Country:US
Practice Address - Phone:917-880-2675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-26
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002599101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health