Provider Demographics
NPI:1356698450
Name:MITCHELL, AMY LAUREN (PSYD)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:LAUREN
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:852 MASSACHUSETTS AVE
Mailing Address - Street 2:APT 6
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-3025
Mailing Address - Country:US
Mailing Address - Phone:908-377-2143
Mailing Address - Fax:
Practice Address - Street 1:875 MASSACHUSETTS AVE
Practice Address - Street 2:SUITE 61
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-3067
Practice Address - Country:US
Practice Address - Phone:617-388-7920
Practice Address - Fax:617-649-8846
Is Sole Proprietor?:No
Enumeration Date:2012-08-07
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY018924103TC0700X
MA9498103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical