Provider Demographics
NPI:1063824837
Name:MITTNER, MARGARET (LICSW)
Entity Type:Individual
Prefix:MS
First Name:MARGARET
Middle Name:
Last Name:MITTNER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 COLLEGE RD
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02908-2204
Mailing Address - Country:US
Mailing Address - Phone:401-365-0257
Mailing Address - Fax:401-831-0661
Practice Address - Street 1:295 ANGELL ST
Practice Address - Street 2:STE 1D
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-2119
Practice Address - Country:US
Practice Address - Phone:401-365-0257
Practice Address - Fax:216-677-9313
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-28
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1246201041C0700X
RIISW024191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical