Healthcare Provider Details

I. General information

NPI: 1386470862
Provider Name (Legal Business Name): TORI MITTELMAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2024
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 LEOPARD RD STE 203
PAOLI PA
19301-1552
US

IV. Provider business mailing address

213 CATTELL AVE
COLLINGSWOOD NJ
08107-2310
US

V. Phone/Fax

Practice location:
  • Phone: 215-282-3004
  • Fax: 215-282-8597
Mailing address:
  • Phone: 703-424-0741
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW026613
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: