Provider Demographics
NPI:1386410645
Name:SCHROEDER, HARLEY JAMES (RADT1)
Entity type:Individual
Prefix:
First Name:HARLEY
Middle Name:JAMES
Last Name:SCHROEDER
Suffix:
Gender:M
Credentials:RADT1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:426 WEST ST # 1/2
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95688-4518
Mailing Address - Country:US
Mailing Address - Phone:707-724-9018
Mailing Address - Fax:707-724-9018
Practice Address - Street 1:1149 WARREN AVE
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94591-7512
Practice Address - Country:US
Practice Address - Phone:707-592-5295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-28
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
CA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)