Provider Demographics
NPI:1013202159
Name:MITCHELL, AIGNER MICHELLE (MSW)
Entity type:Individual
Prefix:MS
First Name:AIGNER
Middle Name:MICHELLE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:645 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06095-3227
Mailing Address - Country:US
Mailing Address - Phone:860-688-6730
Mailing Address - Fax:
Practice Address - Street 1:645 PARK AVE
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06095-3227
Practice Address - Country:US
Practice Address - Phone:860-688-6730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-16
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker