Provider Demographics
NPI:1669953709
Name:SCHMIDT, GARY PAUL JR (LCSW)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:PAUL
Last Name:SCHMIDT
Suffix:JR
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4546 OAKLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1523
Mailing Address - Country:US
Mailing Address - Phone:573-200-1531
Mailing Address - Fax:
Practice Address - Street 1:4546 OAKLAND AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1523
Practice Address - Country:US
Practice Address - Phone:573-200-1531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-27
Last Update Date:2022-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018030145104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker