Provider Demographics
NPI:1568930477
Name:SCHMITT, CHRISTINE IRENE
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:IRENE
Last Name:SCHMITT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6545 GLIDDEN LN
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-6946
Mailing Address - Country:US
Mailing Address - Phone:858-248-1067
Mailing Address - Fax:
Practice Address - Street 1:6545 GLIDDEN LN
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-6946
Practice Address - Country:US
Practice Address - Phone:858-248-1067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-08
Last Update Date:2021-09-27
Deactivation Date:2018-12-14
Deactivation Code:
Reactivation Date:2018-12-19
Provider Licenses
StateLicense IDTaxonomies
1041S0200X, 390200000X
CAASW100340101Y00000X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1568930477OtherGROUP HOME