Provider Demographics
NPI:1669712022
Name:MITCHELL, RENE ADELE
Entity type:Individual
Prefix:
First Name:RENE
Middle Name:ADELE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4887 STATE ROUTE 96A
Mailing Address - Street 2:
Mailing Address - City:ROMULUS
Mailing Address - State:NY
Mailing Address - Zip Code:14541-9767
Mailing Address - Country:US
Mailing Address - Phone:585-610-2541
Mailing Address - Fax:
Practice Address - Street 1:4887 STATE ROUTE 96A
Practice Address - Street 2:
Practice Address - City:ROMULUS
Practice Address - State:NY
Practice Address - Zip Code:14541-9767
Practice Address - Country:US
Practice Address - Phone:585-610-2541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-22
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)