Provider Demographics
NPI:1801138029
Name:TRICHON, MITCHELL (PHD, CCC-SLP)
Entity type:Individual
Prefix:PROF
First Name:MITCHELL
Middle Name:
Last Name:TRICHON
Suffix:
Gender:M
Credentials:PHD, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 COURT ST STE 102
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-4918
Mailing Address - Country:US
Mailing Address - Phone:718-935-4000
Mailing Address - Fax:
Practice Address - Street 1:65 COURT ST STE 102
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-4918
Practice Address - Country:US
Practice Address - Phone:718-935-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-26
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY024013-01235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program