Provider Demographics
NPI:1144368424
Name:SCHMIDT, JEROME R (PH D)
Entity type:Individual
Prefix:
First Name:JEROME
Middle Name:R
Last Name:SCHMIDT
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 S CONGRESS AVE
Mailing Address - Street 2:SUITE 215 D
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-8706
Mailing Address - Country:US
Mailing Address - Phone:512-442-5002
Mailing Address - Fax:512-445-2035
Practice Address - Street 1:611 S CONGRESS AVE
Practice Address - Street 2:SUITE 215 D
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-8706
Practice Address - Country:US
Practice Address - Phone:512-442-5002
Practice Address - Fax:512-445-2035
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22255103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist