Provider Demographics
NPI:1578018511
Name:MITCHELL, BRIAN J (LICSW)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:J
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:LICSW
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 791
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02050-0791
Mailing Address - Country:US
Mailing Address - Phone:508-837-6731
Mailing Address - Fax:
Practice Address - Street 1:555 EASTERN AVE
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02723-2420
Practice Address - Country:US
Practice Address - Phone:508-837-6731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-19
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1197531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical