Provider Demographics
NPI:1255391835
Name:SCHMIDT, PHILIP SCOTT (MS, LMHC)
Entity type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:SCOTT
Last Name:SCHMIDT
Suffix:
Gender:M
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1716 N.E. 16TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33305-0000
Mailing Address - Country:US
Mailing Address - Phone:954-462-5353
Mailing Address - Fax:954-462-5393
Practice Address - Street 1:16. S.E. 18TH STREET
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-0000
Practice Address - Country:US
Practice Address - Phone:954-462-5353
Practice Address - Fax:954-462-5393
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-27
Last Update Date:2009-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH3131103T00000X, 103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL768562900Medicaid