MEDICARE: MR. PHILIP SCOTT SCHMIDT M.S., L.M.H.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	MH3131	FL
2	103TP2701X	Group Psychotherapy Psychologist	MH3131	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255391835
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PHILIP SCOTT SCHMIDT M.S., L.M.H.C.

Provider Business Mailing Address
First Line	:	1716 N.E. 16TH AVENUE
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33305-0000
Country	:	US
Telephone Number	:	954-462-5353
Fax Number	:	954-462-5393

Provider Business Practice Location Address
First Line	:	16. S.E. 18TH STREET
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33316-0000
Country	:	US
Telephone Number	:	954-462-5353
Fax Number	:	954-462-5393

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/27/2006
Last Update Date	:	12/24/2009

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