Provider Demographics
NPI:1659549376
Name:MITCHELL, RUTH A (LMSW)
Entity Type:Individual
Prefix:MS
First Name:RUTH
Middle Name:A
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13827-1579
Mailing Address - Country:US
Mailing Address - Phone:607-687-3540
Mailing Address - Fax:607-687-3911
Practice Address - Street 1:153 MAIN ST
Practice Address - Street 2:
Practice Address - City:OWEGO
Practice Address - State:NY
Practice Address - Zip Code:13827-1579
Practice Address - Country:US
Practice Address - Phone:607-687-3540
Practice Address - Fax:607-687-3911
Is Sole Proprietor?:No
Enumeration Date:2008-02-15
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY068541-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical