Provider Demographics
NPI:1992897334
Name:SCHROEDER, RANDALL ALLEN (PHD)
Entity type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:ALLEN
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 1:4850 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46033-9818
Mailing Address - Country:US
Mailing Address - Phone:260-348-8777
Mailing Address - Fax:
Practice Address - Street 1:4850 E MAIN ST
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46033-9818
Practice Address - Country:US
Practice Address - Phone:260-348-8777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2023-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INLMFT35000635106H00000X
INLCSW340030521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200424360AMedicaid
IN200424360AMedicaid