Provider Demographics
NPI:1437917986
Name:MITTNACHT, VIRGINIA (LCSW)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:
Last Name:MITTNACHT
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 1:414 S 16TH ST UNIT 305
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19146-1989
Mailing Address - Country:US
Mailing Address - Phone:609-240-9406
Mailing Address - Fax:
Practice Address - Street 1:414 S 16TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19146-1989
Practice Address - Country:US
Practice Address - Phone:609-240-9406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0242681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical