Basic Information
Provider Information
NPI: 1205860699
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SCHMITZ
FirstName: PATRICE
MiddleName: E
NamePrefix: MS.
NameSuffix:  
Credential: LCSW
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 508 FULTON ST
Address2: DVAMC
City: DURHAM
State: NC
PostalCode: 27705
CountryCode: US
TelephoneNumber: 9192860411
FaxNumber: 9194165834
Practice Location
Address1: 508 FULTON ST
Address2: DVAMC
City: DURHAM
State: NC
PostalCode: 27705
CountryCode: US
TelephoneNumber: 9192860411
FaxNumber: 9194165834
Other Information
ProviderEnumerationDate: 07/10/2006
LastUpdateDate: 11/18/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1041C0700X0004363NCY Behavioral Health & Social Service ProvidersSocial WorkerClinical

No ID Information.


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