Provider Demographics
NPI:1356439442
Name:SCHMIDT, THERESE N (LCSW)
Entity Type:Individual
Prefix:MS
First Name:THERESE
Middle Name:N
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:THERESE
Other - Middle Name:N
Other - Last Name:SCHMIDT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:1580 N NORTHWEST HWY
Mailing Address - Street 2:STE 121F
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068
Mailing Address - Country:US
Mailing Address - Phone:847-827-7639
Mailing Address - Fax:847-827-7639
Practice Address - Street 1:1580 N NORTHWEST HWY
Practice Address - Street 2:STE 121F
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068
Practice Address - Country:US
Practice Address - Phone:847-827-7639
Practice Address - Fax:847-827-7639
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490000501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
379620Medicare ID - Type Unspecified