Healthcare Provider Details

I. General information

NPI: 1972157584
Provider Name (Legal Business Name): ELIZABETH MITTAL LPCMH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2019
Last Update Date: 05/15/2025
Certification Date: 05/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

262 CHAPMAN RD STE 214
NEWARK DE
19702-5448
US

IV. Provider business mailing address

262 CHAPMAN RD STE 214
NEWARK DE
19702-5448
US

V. Phone/Fax

Practice location:
  • Phone: 267-495-6758
  • Fax: 302-224-1402
Mailing address:
  • Phone: 267-495-6758
  • Fax: 302-224-1402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC-0011533
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: