Provider Demographics
NPI:1801941448
Name:SCHMITT, BETH BRODERICK (LICSW)
Entity type:Individual
Prefix:MS
First Name:BETH
Middle Name:BRODERICK
Last Name:SCHMITT
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 MORGAN ST
Mailing Address - Street 2:
Mailing Address - City:MELROSE
Mailing Address - State:MA
Mailing Address - Zip Code:02176-1241
Mailing Address - Country:US
Mailing Address - Phone:781-662-4411
Mailing Address - Fax:781-395-2909
Practice Address - Street 1:84 HIGH ST
Practice Address - Street 2:2A
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:781-395-2909
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1049721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPO3171OtherBLUE CROSS BLUE SHIELD
MAPO3171OtherBLUE CROSS BLUE SHIELD