Provider Demographics
NPI:1679770168
Name:BETH B. SCHMITT, LICSW, PC
Entity Type:Organization
Organization Name:BETH B. SCHMITT, LICSW, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BETH
Authorized Official - Middle Name:B
Authorized Official - Last Name:SCHMITT
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:781-662-4890
Mailing Address - Street 1:84 HIGH ST
Mailing Address - Street 2:SUITE2A
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-3844
Mailing Address - Country:US
Mailing Address - Phone:781-662-4890
Mailing Address - Fax:
Practice Address - Street 1:84 HIGH ST
Practice Address - Street 2:SUITE2A
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-3844
Practice Address - Country:US
Practice Address - Phone:781-662-4890
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-28
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA104972101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP10239OtherBLUE CROSS BLUE SHIELD