Healthcare Provider Details

I. General information

NPI: 1710171459
Provider Name (Legal Business Name): SUSAN ANNE MITCHELL LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2007
Last Update Date: 09/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 MILLIKEN BLVD CENTER FOR BEHAVIORAL MEDICINE
FALL RIVER MA
02721-1623
US

IV. Provider business mailing address

10 DEER RUN
MATTAPOISETT MA
02739-1243
US

V. Phone/Fax

Practice location:
  • Phone: 508-674-7000
  • Fax: 508-678-6330
Mailing address:
  • Phone: 508-758-3645
  • Fax: 508-678-6330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number106981
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: