Provider Demographics
NPI:1952748535
Name:SCHMIDT, SANDRA L (LCSW)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:L
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:SANDRA
Other - Middle Name:L
Other - Last Name:FULTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:801 BRICKELL AVE STE 900
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33131-2979
Mailing Address - Country:US
Mailing Address - Phone:888-684-2779
Mailing Address - Fax:
Practice Address - Street 1:801 BRICKELL AVE STE 900
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33131-2979
Practice Address - Country:US
Practice Address - Phone:888-684-2779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-23
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD157271041C0700X
FLSW181811041C0700X
FL181811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical