Provider Demographics
NPI:1831634039
Name:SCHMIDT, ROBERT M (LMSW, CADC)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:M
Last Name:SCHMIDT
Suffix:
Gender:M
Credentials:LMSW, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 BLUE RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:OROFINO
Mailing Address - State:ID
Mailing Address - Zip Code:83544-9019
Mailing Address - Country:US
Mailing Address - Phone:208-305-5386
Mailing Address - Fax:
Practice Address - Street 1:232 BLUE RIDGE CT
Practice Address - Street 2:
Practice Address - City:OROFINO
Practice Address - State:ID
Practice Address - Zip Code:83544-9019
Practice Address - Country:US
Practice Address - Phone:208-305-5386
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-23
Last Update Date:2016-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-33617104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker