Provider Demographics
NPI:1760532592
Name:MITCHELL, ERIC ROBERT (PHD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:ROBERT
Last Name:MITCHELL
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 1:6810 EMLEN ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19119-2641
Mailing Address - Country:US
Mailing Address - Phone:215-844-6482
Mailing Address - Fax:
Practice Address - Street 1:6810 EMLEN ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19119-2641
Practice Address - Country:US
Practice Address - Phone:215-844-6482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS-015035103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist