Provider Demographics
NPI:1326487950
Name:SCHMIDT, KRISTY (LCSW)
Entity Type:Individual
Prefix:
First Name:KRISTY
Middle Name:
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94 LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-2939
Mailing Address - Country:US
Mailing Address - Phone:201-303-5677
Mailing Address - Fax:
Practice Address - Street 1:63 BEAVERBROOK RD
Practice Address - Street 2:SUITE 102
Practice Address - City:LINCOLN PARK
Practice Address - State:NJ
Practice Address - Zip Code:07035-1440
Practice Address - Country:US
Practice Address - Phone:973-696-0800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-17
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC055153001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical