Provider Demographics
NPI:1821112996
Name:MITCHELL, GLORIA (PHD)
Entity Type:Individual
Prefix:DR
First Name:GLORIA
Middle Name:
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 1:141 E 55TH ST
Mailing Address - Street 2:SUITE 9G
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-4030
Mailing Address - Country:US
Mailing Address - Phone:212-935-8842
Mailing Address - Fax:212-754-0950
Practice Address - Street 1:141 E 55TH ST
Practice Address - Street 2:#9G
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-4030
Practice Address - Country:US
Practice Address - Phone:121-293-5884
Practice Address - Fax:121-275-4095
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014913103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP2706074Medicare UPIN
NYVL 8012Medicare ID - Type Unspecified
NY345072Medicare UPIN