Healthcare Provider Details

I. General information

NPI: 1568390995
Provider Name (Legal Business Name): MICHELLE MITCHELL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 ELM ST UNIT 203185
NEW HAVEN CT
06520-9381
US

IV. Provider business mailing address

12 WOODLAND WALK
DERBY CT
06418-2258
US

V. Phone/Fax

Practice location:
  • Phone: 973-960-9672
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number004441
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: