Healthcare Provider Details

I. General information

NPI: 1053771113
Provider Name (Legal Business Name): ROBIN MITCHELL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2016
Last Update Date: 03/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 WEST ST
BROOKLYN NY
11222-2093
US

IV. Provider business mailing address

97 DUPONT ST APT 3
BROOKLYN NY
11222-6151
US

V. Phone/Fax

Practice location:
  • Phone: 347-397-0391
  • Fax:
Mailing address:
  • Phone: 347-241-3565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number001596-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: