Provider Demographics
NPI:1952365462
Name:SCHNEIDERS, JAY L (PHD, ABPP)
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:L
Last Name:SCHNEIDERS
Suffix:
Gender:M
Credentials:PHD, ABPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3601 S CLARKSON ST STE 530
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80113-3949
Mailing Address - Country:US
Mailing Address - Phone:720-587-7173
Mailing Address - Fax:720-441-0484
Practice Address - Street 1:3601 S CLARKSON ST STE 530
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-3949
Practice Address - Country:US
Practice Address - Phone:720-587-7173
Practice Address - Fax:720-441-0484
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-12
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TH0004X, 103TH0100X
CO1152103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07011521Medicaid
CO07011521Medicaid
CO91596Medicare ID - Type UnspecifiedMEDICARE NUMBER