Provider Demographics
NPI:1962411975
Name:SCHROEDER, HAROLD (PHD)
Entity type:Individual
Prefix:
First Name:HAROLD
Middle Name:
Last Name:SCHROEDER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7234 DILLMAN DR
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:OH
Mailing Address - Zip Code:44236-2410
Mailing Address - Country:US
Mailing Address - Phone:330-672-3787
Mailing Address - Fax:
Practice Address - Street 1:111 S DIAMOND ST
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44902-7510
Practice Address - Country:US
Practice Address - Phone:330-672-3787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1142103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000299579OtherANTHEM PROVIDER NUMBER
OH0282911Medicaid
OH000000299579OtherANTHEM PROVIDER NUMBER