Provider Demographics
NPI:1477551547
Name:MITCHELL, RICHARD S (PHD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:S
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 SHIRLEY AVE
Mailing Address - Street 2:
Mailing Address - City:DENNIS PORT
Mailing Address - State:MA
Mailing Address - Zip Code:02639-2443
Mailing Address - Country:US
Mailing Address - Phone:508-394-8677
Mailing Address - Fax:508-394-1180
Practice Address - Street 1:15 SHIRLEY AVENUE
Practice Address - Street 2:
Practice Address - City:DENNIS PORT
Practice Address - State:MA
Practice Address - Zip Code:02639-5590
Practice Address - Country:US
Practice Address - Phone:508-394-8677
Practice Address - Fax:508-394-1180
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-12
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA396103TC1900X, 103TF0000X, 103TH0100X, 103TM1800X, 103TM1800X
MA00396103TB0200X, 103TC2200X, 103TA0700X, 103T00000X, 103TC0700X, 103TA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0504793Medicaid
MA0504793Medicaid