Healthcare Provider Details

I. General information

NPI: 1780934554
Provider Name (Legal Business Name): MS. CYNTHIA MARIE MITCHELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2012
Last Update Date: 09/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

288 BEDFORD ST
WHITMAN MA
02382-1820
US

IV. Provider business mailing address

3 1ST ST APT 2
TAUNTON MA
02780-4810
US

V. Phone/Fax

Practice location:
  • Phone: 781-447-6425
  • Fax:
Mailing address:
  • Phone: 774-501-2196
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

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: