Provider Demographics
NPI:1306628417
Name:MITCHELL, CORA (ASW)
Entity type:Individual
Prefix:
First Name:CORA
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:ASW
Other - Prefix:
Other - First Name:CORA
Other - Middle Name:
Other - Last Name:BOHACEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:287 LORTON AVE
Mailing Address - Street 2:
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-4203
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1373 KEYWOOD CT
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94521-3713
Practice Address - Country:US
Practice Address - Phone:925-914-0643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-16
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW1029401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical