Healthcare Provider Details

I. General information

NPI: 1255391835
Provider Name (Legal Business Name): PHILIP SCOTT SCHMIDT M.S., L.M.H.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2006
Last Update Date: 12/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16. S.E. 18TH STREET
FORT LAUDERDALE FL
33316-0000
US

IV. Provider business mailing address

1716 N.E. 16TH AVENUE
FORT LAUDERDALE FL
33305-0000
US

V. Phone/Fax

Practice location:
  • Phone: 954-462-5353
  • Fax: 954-462-5393
Mailing address:
  • Phone: 954-462-5353
  • Fax: 954-462-5393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberMH3131
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License NumberMH3131
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: