Provider Demographics
NPI:1356498703
Name:SCHMIDT, MICHAEL THOMAS (MSW LCSW)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:THOMAS
Last Name:SCHMIDT
Suffix:
Gender:M
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 WEST END AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10025
Mailing Address - Country:US
Mailing Address - Phone:212-865-5358
Mailing Address - Fax:
Practice Address - Street 1:4401 BRONX BOULEVARD
Practice Address - Street 2:OUR LADY OF MERCY MEDICAL CENTER MENTAL HEALTH CLINIC
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10470
Practice Address - Country:US
Practice Address - Phone:718-304-7020
Practice Address - Fax:718-304-7065
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR01723211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
N62421Medicare ID - Type Unspecified