Healthcare Provider Details

I. General information

NPI: 1861264277
Provider Name (Legal Business Name): MELISA NOEL MITCHELL MSW, LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2023
Last Update Date: 10/30/2023
Certification Date: 10/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3210 CHESTNUT ST STE 201
PHILADELPHIA PA
19104-5407
US

IV. Provider business mailing address

7536 DICKENS PL
PHILADELPHIA PA
19153-1311
US

V. Phone/Fax

Practice location:
  • Phone: 215-895-1415
  • Fax:
Mailing address:
  • Phone: 267-648-4358
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License NumberSW136745
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License NumberSW136745
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW136745
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: