Healthcare Provider Details

I. General information

NPI: 1013982537
Provider Name (Legal Business Name): PATRICIA PORTO SCHMIDT M. A.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5100 78TH AVE SUITE 7
PINELLAS PARK FL
33781-2407
US

IV. Provider business mailing address

7200 18TH ST NE
SAINT PETERSBURG FL
33702-4757
US

V. Phone/Fax

Practice location:
  • Phone: 727-586-0636
  • Fax: 727-585-6287
Mailing address:
  • Phone: 727-527-3498
  • Fax: 727-526-4487

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH3723
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: