Provider Demographics
NPI:1447702527
Name:SCHNEIDER, MAYRA
Entity type:Individual
Prefix:
First Name:MAYRA
Middle Name:
Last Name:SCHNEIDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1407 LOCHNER RD STE 0
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21239-2932
Mailing Address - Country:US
Mailing Address - Phone:443-475-0338
Mailing Address - Fax:410-475-0338
Practice Address - Street 1:1407 LOCHNER RD STE 0
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21239-2932
Practice Address - Country:US
Practice Address - Phone:443-475-0338
Practice Address - Fax:410-878-0382
Is Sole Proprietor?:No
Enumeration Date:2016-10-25
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP9797101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health