Provider Demographics
NPI:1710744057
Name:SCHMIDT, JOSEPH HENRY (PHD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:HENRY
Last Name:SCHMIDT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12412 CAMINITO BRIOSO
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131-3560
Mailing Address - Country:US
Mailing Address - Phone:619-218-1919
Mailing Address - Fax:
Practice Address - Street 1:12412 CAMINITO BRIOSO
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92131-3560
Practice Address - Country:US
Practice Address - Phone:619-218-1919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY13795103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist