Provider Demographics
NPI:1033936398
Name:MITCHELL, RUTH ELAINE (CASAC 2)
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:ELAINE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:CASAC 2
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1651 METROPOLITAN AVE APT 2A
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-6287
Mailing Address - Country:US
Mailing Address - Phone:917-756-8136
Mailing Address - Fax:
Practice Address - Street 1:1651 METROPOLITAN AVE APT 2A
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-6287
Practice Address - Country:US
Practice Address - Phone:917-756-8136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-26
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY24096101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)