Provider Demographics
NPI:1760635163
Name:MITCHELL, PAMELA LAUREN (PHD)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:LAUREN
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 WIRELESS BLVD
Mailing Address - Street 2:
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-3965
Mailing Address - Country:US
Mailing Address - Phone:631-382-7311
Mailing Address - Fax:
Practice Address - Street 1:49 WIRELESS BLVD
Practice Address - Street 2:
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-3965
Practice Address - Country:US
Practice Address - Phone:631-382-7311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-29
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017352103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool