Healthcare Provider Details

I. General information

NPI: 1316373871
Provider Name (Legal Business Name): ELIZABETH ANN SCHMITT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2013
Last Update Date: 09/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

414 GRESHAM AVE
DURHAM NC
27704-4214
US

IV. Provider business mailing address

414 GRESHAM AVE
DURHAM NC
27704-4214
US

V. Phone/Fax

Practice location:
  • Phone: 919-995-5095
  • Fax:
Mailing address:
  • Phone: 919-995-5095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number2397
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: