Provider Demographics
NPI:1982211017
Name:MITSOCK, MICHELA
Entity Type:Individual
Prefix:
First Name:MICHELA
Middle Name:
Last Name:MITSOCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 ALGONQUIN RD
Mailing Address - Street 2:
Mailing Address - City:CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01824-4732
Mailing Address - Country:US
Mailing Address - Phone:978-846-2152
Mailing Address - Fax:
Practice Address - Street 1:1 WHITNEY RD
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:MA
Practice Address - Zip Code:01503-1653
Practice Address - Country:US
Practice Address - Phone:855-222-7980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-23
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst