Provider Demographics
NPI:1205117546
Name:MITARITONNA, RACHEL MARIE (SWI)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:MARIE
Last Name:MITARITONNA
Suffix:
Gender:F
Credentials:SWI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2244 JACKSON AVE APT 813
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11101-9409
Mailing Address - Country:US
Mailing Address - Phone:631-793-7377
Mailing Address - Fax:
Practice Address - Street 1:235 MAIN ST STE 250
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601-2418
Practice Address - Country:US
Practice Address - Phone:212-362-4490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-31
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC060489001041C0700X
CT0134141041C0700X
NY0873891041C0700X
1041C0700X
NY089303104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker