MEDICARE: DR. LORRAINE ADASSA MITCHELL PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	SW 8484	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	600024829	OTHER	FL	MAGELLAN HEALTH

General Provider Information

NPI Number	:	1134349665
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LORRAINE ADASSA MITCHELL PH.D.

Provider Business Mailing Address
First Line	:	1265 NW 127TH ST
Second Line	:
City	:	NORTH MIAMI
State	:	FL
Zip	:	33167-2204
Country	:	US
Telephone Number	:	305-439-6957
Fax Number	:	305-688-8765

Provider Business Practice Location Address
First Line	:	1265 NW 127TH ST
Second Line	:
City	:	NORTH MIAMI
State	:	FL
Zip	:	33167-2204
Country	:	US
Telephone Number	:	305-439-6957
Fax Number	:	305-688-8765

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/26/2007
Last Update Date	:	02/03/2009

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