MEDICARE: DR. CAROLYN FINN 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	103T00000X	Psychologist	PSY19906	CA

General Provider Information

NPI Number	:	1487630810
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CAROLYN FINN MITCHELL PH.D.

Provider Business Mailing Address
First Line	:	PO BOX 111864
Second Line	:
City	:	CAMPBELL
State	:	CA
Zip	:	95011-1864
Country	:	US
Telephone Number	:	408-235-1566
Fax Number	:

Provider Business Practice Location Address
First Line	:	940 SARATOGA AVE
Second Line	:	SUITE 200
City	:	SAN JOSE
State	:	CA
Zip	:	95129-3428
Country	:	US
Telephone Number	:	408-235-1566
Fax Number	:

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

Provider Enumeration Date	:	12/18/2005
Last Update Date	:	07/08/2007

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