Provider Demographics
NPI:1619413168
Name:SCHMIDT, SUSANNE (MS, LCMHC)
Entity Type:Individual
Prefix:
First Name:SUSANNE
Middle Name:
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:MS, LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 CLIFF ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-4505
Mailing Address - Country:US
Mailing Address - Phone:802-444-2505
Mailing Address - Fax:
Practice Address - Street 1:24 CLIFF ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-4505
Practice Address - Country:US
Practice Address - Phone:802-444-2505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-09
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068.0000378101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health