Healthcare Provider Details

I. General information

NPI: 1356078364
Provider Name (Legal Business Name): ERIC SCHMIDT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2022
Last Update Date: 12/13/2025
Certification Date: 12/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 SARNO RD STE 1
MELBOURNE FL
32935-3989
US

IV. Provider business mailing address

1801 SARNO RD STE 1
MELBOURNE FL
32935-3989
US

V. Phone/Fax

Practice location:
  • Phone: 321-622-4066
  • Fax:
Mailing address:
  • Phone: 321-622-4066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMH28740
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: