Provider Demographics
NPI:1902889074
Name:SCHMIDT, MATTHEW DANIEL (LSCSW)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:DANIEL
Last Name:SCHMIDT
Suffix:
Gender:M
Credentials:LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 S PINE ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:KS
Mailing Address - Zip Code:67114-3745
Mailing Address - Country:US
Mailing Address - Phone:316-283-6103
Mailing Address - Fax:316-283-0453
Practice Address - Street 1:209 S PINE ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:KS
Practice Address - Zip Code:67114-3745
Practice Address - Country:US
Practice Address - Phone:316-283-6103
Practice Address - Fax:316-283-0453
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2013-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS22371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
069751Medicare ID - Type Unspecified