Provider Demographics
NPI:1780764183
Name:MITCH, ANNE ELIZABETH (CNS,LP)
Entity type:Individual
Prefix:MS
First Name:ANNE
Middle Name:ELIZABETH
Last Name:MITCH
Suffix:
Gender:F
Credentials:CNS,LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 MADISON AVE
Mailing Address - Street 2:SUITE 1108AND 608
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-0801
Mailing Address - Country:US
Mailing Address - Phone:646-335-3619
Mailing Address - Fax:
Practice Address - Street 1:280 MADISON AVE
Practice Address - Street 2:SUITE 1108 AND 608
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-0801
Practice Address - Country:US
Practice Address - Phone:646-335-3619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY131221163WP0809X
NY00347-1101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA300054173OtherPTAN #A300054173
NY131221-1OtherREGISTERED NURSE
000347OtherPSYCHOANALYST LICENSE