Provider Demographics
NPI:1639298045
Name:MITCHELL, DEBRA A (LCSWR)
Entity Type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:A
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:LCSWR
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:A
Other - Last Name:SKOLL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CSW
Mailing Address - Street 1:80 STATE HIGHWAY 310
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CANTON
Mailing Address - State:NY
Mailing Address - Zip Code:13617-1493
Mailing Address - Country:US
Mailing Address - Phone:315-386-2167
Mailing Address - Fax:315-386-2435
Practice Address - Street 1:80 STATE HIGHWAY 310
Practice Address - Street 2:SUITE 1
Practice Address - City:CANTON
Practice Address - State:NY
Practice Address - Zip Code:13617-1493
Practice Address - Country:US
Practice Address - Phone:315-386-2167
Practice Address - Fax:315-386-2435
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR062033104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker