Healthcare Provider Details

I. General information

NPI: 1548649353
Provider Name (Legal Business Name): LARRY JOHN SCHMIDT LBSW, QIDP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2015
Last Update Date: 08/01/2024
Certification Date: 08/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35425 W MICHIGAN AVE
WAYNE MI
48184-9800
US

IV. Provider business mailing address

35425 W MICHIGAN AVE
WAYNE MI
48184-9800
US

V. Phone/Fax

Practice location:
  • Phone: 734-467-7600
  • Fax:
Mailing address:
  • Phone: 734-467-7600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6802065469
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: