Healthcare Provider Details

I. General information

NPI: 1801781356
Provider Name (Legal Business Name): AMY MIITCHELL CSP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2025
Last Update Date: 06/12/2025
Certification Date: 06/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

246 PARK ST # 3314
WEST SPRINGFIELD MA
01089-3314
US

IV. Provider business mailing address

26 RIMMON AVE
SPRINGFIELD MA
01107-1304
US

V. Phone/Fax

Practice location:
  • Phone: 413-737-4718
  • Fax:
Mailing address:
  • Phone: 413-977-2649
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: