Provider Demographics
NPI:1720477110
Name:MITCHELL, KATRINA (MA)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 NEPONSET AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02122-3169
Mailing Address - Country:US
Mailing Address - Phone:857-217-3700
Mailing Address - Fax:857-217-3750
Practice Address - Street 1:415 NEPONSET AVE STE 3
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02122-3169
Practice Address - Country:US
Practice Address - Phone:857-217-3700
Practice Address - Fax:857-217-3750
Is Sole Proprietor?:No
Enumeration Date:2015-01-22
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health