Provider Demographics
NPI:1689994089
Name:MITCHELL, THOMAS STEVEN (LMSW)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:STEVEN
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2705 JONAS LN
Mailing Address - Street 2:
Mailing Address - City:ENDICOTT
Mailing Address - State:NY
Mailing Address - Zip Code:13760-7000
Mailing Address - Country:US
Mailing Address - Phone:607-341-1052
Mailing Address - Fax:
Practice Address - Street 1:101 S LODER AVE
Practice Address - Street 2:
Practice Address - City:ENDICOTT
Practice Address - State:NY
Practice Address - Zip Code:13760-4810
Practice Address - Country:US
Practice Address - Phone:607-757-2851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-08
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY060026104100000X
NY6180460511041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool