Provider Demographics
NPI:1386149946
Name:SCHMIDT, RAYMOND PETER (ESQ, MST)
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:PETER
Last Name:SCHMIDT
Suffix:
Gender:M
Credentials:ESQ, MST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7840 81ST ST
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11385-7633
Mailing Address - Country:US
Mailing Address - Phone:347-351-4543
Mailing Address - Fax:
Practice Address - Street 1:7840 81ST ST
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:NY
Practice Address - Zip Code:11385-7633
Practice Address - Country:US
Practice Address - Phone:347-351-4543
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-27
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1193421171106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst