Healthcare Provider Details

I. General information

NPI: 1629462536
Provider Name (Legal Business Name): JOY MITCHELL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2015
Last Update Date: 02/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 ARBOR ST
HARTFORD CT
06106-1215
US

IV. Provider business mailing address

995 DAY HILL RD
WINDSOR CT
06095-1722
US

V. Phone/Fax

Practice location:
  • Phone: 860-904-7890
  • Fax:
Mailing address:
  • Phone: 860-731-5522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number007924
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number007924
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: