Provider Demographics
NPI:1558044172
Name:MITCHELL, LEVAR (LMSW)
Entity Type:Individual
Prefix:MR
First Name:LEVAR
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 GOSLEE DR APT 51
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-5847
Mailing Address - Country:US
Mailing Address - Phone:860-656-5366
Mailing Address - Fax:
Practice Address - Street 1:642 HILLIARD ST STE 1310
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06042-2700
Practice Address - Country:US
Practice Address - Phone:860-422-5762
Practice Address - Fax:877-402-8266
Is Sole Proprietor?:No
Enumeration Date:2023-08-10
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT8354104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker