Provider Demographics
NPI:1093111528
Name:MITCHELL, ELISABETH SHERIDAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:ELISABETH
Middle Name:SHERIDAN
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 BANK ST APT 206K
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10606-7002
Mailing Address - Country:US
Mailing Address - Phone:205-329-0392
Mailing Address - Fax:
Practice Address - Street 1:21 BLOOMINGDALE RD
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10605-1504
Practice Address - Country:US
Practice Address - Phone:914-997-5533
Practice Address - Fax:914-997-8626
Is Sole Proprietor?:No
Enumeration Date:2014-11-11
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003818103TC0700X
NY020982103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical