Provider Demographics
NPI:1760494439
Name:SCHMIDT, KIM M (LCSWR, LMFT)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:M
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:LCSWR, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1721 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DUNEDIN
Mailing Address - State:FL
Mailing Address - Zip Code:34698-6402
Mailing Address - Country:US
Mailing Address - Phone:727-734-5276
Mailing Address - Fax:
Practice Address - Street 1:1721 MAIN ST
Practice Address - Street 2:
Practice Address - City:DUNEDIN
Practice Address - State:FL
Practice Address - Zip Code:34698-6402
Practice Address - Country:US
Practice Address - Phone:727-734-5276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2009-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0562621041C0700X
NY000514106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist