Basic Information
| Provider Information | |||||||||
| NPI: | 1992235113 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCHROEDER | ||||||||
| FirstName: | ANGELA | ||||||||
| MiddleName: | RENEE' | ||||||||
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| Credential: | LMHC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 40 RIVER RD | ||||||||
| Address2: | |||||||||
| City: | MARION | ||||||||
| State: | MA | ||||||||
| PostalCode: | 027381108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5082075930 | ||||||||
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| Practice Location | |||||||||
| Address1: | 543 NORTH ST | ||||||||
| Address2: | |||||||||
| City: | NEW BEDFORD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 027402782 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5089845566 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2017 | ||||||||
| LastUpdateDate: | 11/30/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 12015 | MA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.