Provider Demographics
NPI:1821436783
Name:MITCHELL, BERNADETTE ELIZABETH (LMT)
Entity Type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:ELIZABETH
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:BERNADETTE
Other - Middle Name:ELIZABETH
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMT
Mailing Address - Street 1:742 DENISON ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21229-2041
Mailing Address - Country:US
Mailing Address - Phone:410-375-0032
Mailing Address - Fax:
Practice Address - Street 1:1 E CHASE ST
Practice Address - Street 2:SUITE 1135
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-2526
Practice Address - Country:US
Practice Address - Phone:410-375-0032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-12
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDM04880225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist