Provider Demographics
NPI:1578939187
Name:MITCHELL, WARREN
Entity Type:Individual
Prefix:
First Name:WARREN
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 CARLETONDALE RD
Mailing Address - Street 2:
Mailing Address - City:RINGWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07456-1611
Mailing Address - Country:US
Mailing Address - Phone:973-962-7029
Mailing Address - Fax:973-962-9211
Practice Address - Street 1:121 CARLETONDALE RD
Practice Address - Street 2:
Practice Address - City:RINGWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07456-1611
Practice Address - Country:US
Practice Address - Phone:973-962-7029
Practice Address - Fax:973-962-9211
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-18
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)