Healthcare Provider Details

I. General information

NPI: 1013585306
Provider Name (Legal Business Name): MITSOUKO CHATELAIN MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2021
Last Update Date: 10/03/2026
Certification Date: 10/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8711 RIDGELAND DR
CUTLER BAY FL
33157-7133
US

IV. Provider business mailing address

8711 RIDGELAND DR
CUTLER BAY FL
33157-7133
US

V. Phone/Fax

Practice location:
  • Phone: 754-444-7432
  • Fax:
Mailing address:
  • Phone: 754-444-7432
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number118975
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number13262-C
License Number StateNV
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW25416
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW027548
License Number StatePA
# 5
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149041099
License Number StateIL
# 6
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-24016
License Number StateAZ
# 7
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW09932917
License Number StateCO
# 8
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC020182
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: