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NPI Code Detail

MEDICARE: MITCHELL DOUGLAS LCSW

MEDICARE: MITCHELL DOUGLAS 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
11041C0700XClinical Social WorkerSC04824600NJ

General Provider Information

NPI Number : 1942388269
Entity Type Code : Individual
Provider Name (Legal Business Name) : MITCHELL DOUGLAS LCSW
Provider Business Mailing Address
First Line : 150 W 96TH ST APT 4D
Second Line :
City : NEW YORK
State : NY
Zip : 10025-6443
Country : US
Telephone Number : 646-499-0936
Fax Number :
Provider Business Practice Location Address
First Line : 11 TAMARACK CIR
Second Line :
City : SKILLMAN
State : NJ
Zip : 08558-2019
Country : US
Telephone Number : 609-279-1339
Fax Number : 609-279-1359
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/02/2006
Last Update Date : 04/06/2023

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Directions to “ MITCHELL DOUGLAS LCSW” Practice Location

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