Provider Demographics
NPI:1336255140
Name:SCHWARTZ, MARK F (PSYCHOLOGIST DOCTOR)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:F
Last Name:SCHWARTZ
Suffix:
Gender:M
Credentials:PSYCHOLOGIST DOCTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 HOLLAND RD
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63021
Mailing Address - Country:US
Mailing Address - Phone:636-386-6611
Mailing Address - Fax:
Practice Address - Street 1:800 HOLLAND RD
Practice Address - Street 2:
Practice Address - City:BALLWIN
Practice Address - State:MO
Practice Address - Zip Code:63021
Practice Address - Country:US
Practice Address - Phone:636-386-6611
Practice Address - Fax:636-386-6622
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOPY01565103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO5312526OtherAETNA
MO15018OtherBLUE CROSS BLUE SHIELD