Provider Demographics
NPI:1942899893
Name:MITCHELL, CHINETTA (LMSW)
Entity Type:Individual
Prefix:
First Name:CHINETTA
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MS
Other - First Name:CHINETTA
Other - Middle Name:L
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW
Mailing Address - Street 1:465 W 166TH ST APT 4E
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-4444
Mailing Address - Country:US
Mailing Address - Phone:917-582-8842
Mailing Address - Fax:
Practice Address - Street 1:465 W 166TH ST APT 4E
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-4444
Practice Address - Country:US
Practice Address - Phone:917-582-8842
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-14
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY109311104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker