Provider Demographics
NPI:1275643454
Name:FRANK, MITCHELL M (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:M
Last Name:FRANK
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10915 QUEENS BLVD APT 1K
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-5483
Mailing Address - Country:US
Mailing Address - Phone:718-544-5237
Mailing Address - Fax:
Practice Address - Street 1:11021 73RD RD APT 1J
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-6369
Practice Address - Country:US
Practice Address - Phone:646-331-0322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012366103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical