Provider Demographics
NPI:1568523454
Name:MITCHELL, KRISTIN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:KRISTIN
Middle Name:
Last Name:MITCHELL
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 1:135 S PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05753-4456
Mailing Address - Country:US
Mailing Address - Phone:917-334-8449
Mailing Address - Fax:802-388-1918
Practice Address - Street 1:135 S PLEASANT ST
Practice Address - Street 2:
Practice Address - City:MIDDLEBURY
Practice Address - State:VT
Practice Address - Zip Code:05753-4456
Practice Address - Country:US
Practice Address - Phone:917-334-8449
Practice Address - Fax:802-388-1918
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC050925001041C0700X
NYR059209-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ051123OtherM.H.N.