Provider Demographics
NPI:1407316656
Name:MITCHELL, WENDY MIRIAM (LCSW)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:MIRIAM
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8010 TATUM WATERWAY DR.
Mailing Address - Street 2:SUITE #1
Mailing Address - City:MIAMI BEACH, FL
Mailing Address - State:FL
Mailing Address - Zip Code:33141
Mailing Address - Country:US
Mailing Address - Phone:786-499-8718
Mailing Address - Fax:
Practice Address - Street 1:8010 TATUM WATERWAY DR.
Practice Address - Street 2:SUITE #1
Practice Address - City:MIAMI BEACH, FL
Practice Address - State:FL
Practice Address - Zip Code:33141
Practice Address - Country:US
Practice Address - Phone:786-499-8718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-23
Last Update Date:2019-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW15540101Y00000X, 101YA0400X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)