Provider Demographics
NPI:1780220244
Name:MITCHELL, TONYA NICOEL (BEHAVORIAL TECHNICAN)
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:NICOEL
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:BEHAVORIAL TECHNICAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5700 ARLINGTON AVE APT 15V
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10471-1517
Mailing Address - Country:US
Mailing Address - Phone:646-591-4219
Mailing Address - Fax:
Practice Address - Street 1:329 E 149TH ST FL 4
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-5626
Practice Address - Country:US
Practice Address - Phone:646-666-3088
Practice Address - Fax:844-310-3344
Is Sole Proprietor?:No
Enumeration Date:2019-11-20
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician