Provider Demographics
NPI:1134349665
Name:MITCHELL, LORRAINE ADASSA (PHD)
Entity type:Individual
Prefix:DR
First Name:LORRAINE
Middle Name:ADASSA
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1265 NW 127TH ST
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33167-2204
Mailing Address - Country:US
Mailing Address - Phone:305-439-6957
Mailing Address - Fax:305-688-8765
Practice Address - Street 1:1265 NW 127TH ST
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33167-2204
Practice Address - Country:US
Practice Address - Phone:305-439-6957
Practice Address - Fax:305-688-8765
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 84841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL600024829OtherMAGELLAN HEALTH