MEDICARE: MICHELLE MITCHELL LCSW

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	004441	CT

General Provider Information

NPI Number	:	1568390995
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE MITCHELL LCSW

Provider Business Mailing Address
First Line	:	12 WOODLAND WALK
Second Line	:
City	:	DERBY
State	:	CT
Zip	:	06418-2258
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	206 ELM ST UNIT 203185
Second Line	:
City	:	NEW HAVEN
State	:	CT
Zip	:	06520-9381
Country	:	US
Telephone Number	:	973-960-9672
Fax Number	:

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

Provider Enumeration Date	:	05/13/2026
Last Update Date	:	05/13/2026

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Directions to “ MICHELLE MITCHELL LCSW” Practice Location

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