Healthcare Provider Details

I. General information

NPI: 1851467898
Provider Name (Legal Business Name): JOHN R MITCHELL LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 07/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

887 2ND ST
FALL RIVER MA
02721-1998
US

IV. Provider business mailing address

PO BOX 9506
FALL RIVER MA
02720
US

V. Phone/Fax

Practice location:
  • Phone: 508-415-9171
  • Fax: 508-674-4358
Mailing address:
  • Phone: 508-415-9171
  • Fax: 508-674-4358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1031868
License Number StateMA

VII. Legacy identifiers

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

# 1
Identifier1892223
Identifier TypeMEDICAID
Identifier StateMA
Identifier Issuer
# 2
Identifier407153
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerMAGELLAN
# 3
Identifier21188-8
Identifier TypeOTHER
Identifier StateRI
Identifier IssuerBC BS OF RI
# 4
Identifier1034810
Identifier TypeMEDICAID
Identifier StateMA
Identifier Issuer
# 5
Identifier1034810
Identifier TypeMEDICAID
Identifier StateRI
Identifier Issuer
# 6
Identifier23825
Identifier TypeMEDICAID
Identifier StateMA
Identifier Issuer
# 7
Identifier1851578
Identifier TypeMEDICAID
Identifier StateMA
Identifier Issuer
# 8
Identifier185821
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerVALUE OPTIONS
# 9
Identifier7675509
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerAETNA
# 10
IdentifierP07592
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerBC BS OF MA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: