Provider Demographics
NPI:1487630810
Name:MITCHELL, CAROLYN FINN (PHD)
Entity Type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:FINN
Last Name:MITCHELL
Suffix:
Gender:F
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:PO BOX 111864
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95011-1864
Mailing Address - Country:US
Mailing Address - Phone:408-235-1566
Mailing Address - Fax:
Practice Address - Street 1:940 SARATOGA AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95129-3428
Practice Address - Country:US
Practice Address - Phone:408-235-1566
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY19906103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PL199061Medicare ID - Type Unspecified