Provider Demographics
NPI:1649404484
Name:SCHMIDT, MARILYN ISABELLE (PHD)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:ISABELLE
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5953 CASTLETON DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-4038
Mailing Address - Country:US
Mailing Address - Phone:760-877-0071
Mailing Address - Fax:
Practice Address - Street 1:5953 CASTLETON DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-4038
Practice Address - Country:US
Practice Address - Phone:760-877-0071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-07
Last Update Date:2009-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY22637103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist