Healthcare Provider Details

I. General information

NPI: 1780764183
Provider Name (Legal Business Name): ANNE ELIZABETH MITCH CNS,LP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 02/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 MADISON AVE SUITE 1108 AND 608
NEW YORK NY
10016-0801
US

IV. Provider business mailing address

280 MADISON AVE SUITE 1108AND 608
NEW YORK NY
10016-0801
US

V. Phone/Fax

Practice location:
  • Phone: 646-335-3619
  • Fax:
Mailing address:
  • Phone: 646-335-3619
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number131221
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number00347-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number00347-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: