Provider Demographics
NPI:1780693176
Name:MITCHELL, ILDIKO C (LCSWR)
Entity type:Individual
Prefix:MRS
First Name:ILDIKO
Middle Name:C
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:LCSWR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 MAIN ST
Mailing Address - Street 2:CATHOLIC CHARITIES OF BROOME CO
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13905-2610
Mailing Address - Country:US
Mailing Address - Phone:607-729-9166
Mailing Address - Fax:607-729-2062
Practice Address - Street 1:232 MAIN ST
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13905-2610
Practice Address - Country:US
Practice Address - Phone:607-729-9166
Practice Address - Fax:607-729-2062
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR02988511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
041012000094OtherFIDELLO
249793OtherCOPHP
618805OtherMVP
7406323OtherGHI EMPIRE
618805OtherMVP