Provider Demographics
NPI:1710171459
Name:MITCHELL, SUSAN ANNE (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:ANNE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 DEER RUN
Mailing Address - Street 2:
Mailing Address - City:MATTAPOISETT
Mailing Address - State:MA
Mailing Address - Zip Code:02739-1243
Mailing Address - Country:US
Mailing Address - Phone:508-758-3645
Mailing Address - Fax:508-678-6330
Practice Address - Street 1:222 MILLIKEN BLVD
Practice Address - Street 2:CENTER FOR BEHAVIORAL MEDICINE
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02721-1623
Practice Address - Country:US
Practice Address - Phone:508-674-7000
Practice Address - Fax:508-678-6330
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-05
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1069811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAMIP05745Medicare PIN