Healthcare Provider Details

I. General information

NPI: 1871791715
Provider Name (Legal Business Name): LEORA ANN SCHMIDT L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LEORA ANN DICKSON L.C.S.W.

II. Dates (important events)

Enumeration Date: 07/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 STATE HIGHWAY NO. 17 NORTH SUITE 313
PARAMUS NJ
07652
US

IV. Provider business mailing address

12 STATE HIGHWAY NO. 17 NORTH SUITE 313
PARAMUS NJ
07652
US

V. Phone/Fax

Practice location:
  • Phone: 201-368-3700
  • Fax: 201-368-0055
Mailing address:
  • Phone: 201-368-3700
  • Fax: 201-368-0055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP015154-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: