Provider Demographics
NPI:1609296284
Name:MOISIO, MITCHELL (PHD)
Entity Type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:
Last Name:MOISIO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 LINN DR.
Mailing Address - Street 2:FDR, CLEVELAND MUNICIPAL SCHOOL DISTRICT
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44108
Mailing Address - Country:US
Mailing Address - Phone:216-523-8498
Mailing Address - Fax:
Practice Address - Street 1:800 LINN DR.
Practice Address - Street 2:FDR, CLEVELAND MUNICIPAL SCHOOL DISTRICT
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44108
Practice Address - Country:US
Practice Address - Phone:216-523-8498
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-22
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH20515086103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool