Provider Demographics
NPI:1508263880
Name:JESSICA A. MITCHELL, PSY.D, LLC
Entity Type:Organization
Organization Name:JESSICA A. MITCHELL, PSY.D, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:A
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:860-470-3915
Mailing Address - Street 1:270 FARMINGTON AVE
Mailing Address - Street 2:SUITE 333
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-1909
Mailing Address - Country:US
Mailing Address - Phone:860-470-3915
Mailing Address - Fax:860-470-3958
Practice Address - Street 1:270 FARMINGTON AVE
Practice Address - Street 2:SUITE 333
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-1909
Practice Address - Country:US
Practice Address - Phone:860-470-3915
Practice Address - Fax:860-470-3958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-02
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003084103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty