Provider Demographics
NPI:1629421086
Name:SCHMIDT, KEVIN BLAINE (LCSW#12706)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:BLAINE
Last Name:SCHMIDT
Suffix:
Gender:M
Credentials:LCSW#12706
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4810 W BEXLEY PARK DR
Mailing Address - Street 2:UNIT C
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445-3577
Mailing Address - Country:US
Mailing Address - Phone:305-310-6618
Mailing Address - Fax:561-330-5268
Practice Address - Street 1:2100 LAKE IDA RD
Practice Address - Street 2:STE 2
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-2442
Practice Address - Country:US
Practice Address - Phone:305-310-6618
Practice Address - Fax:561-330-5268
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-20
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLSW 12706101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSW 12706OtherSOCIAL WORK