Provider Demographics
NPI:1205916913
Name:SCHMITZ, HAROLD VINCENT (PHD)
Entity type:Individual
Prefix:
First Name:HAROLD
Middle Name:VINCENT
Last Name:SCHMITZ
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 1:1219 COUNTY ROUTE 13
Mailing Address - Street 2:
Mailing Address - City:OLD CHATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12136-2712
Mailing Address - Country:US
Mailing Address - Phone:518-794-9400
Mailing Address - Fax:518-766-5471
Practice Address - Street 1:1219 COUNTY ROUTE 13
Practice Address - Street 2:
Practice Address - City:OLD CHATHAM
Practice Address - State:NY
Practice Address - Zip Code:12136-2712
Practice Address - Country:US
Practice Address - Phone:518-794-9400
Practice Address - Fax:518-766-5471
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006095103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01731617Medicaid
NYV94801Medicare ID - Type Unspecified