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General NPI Number Information
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NPI Number | 1023398963
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Entity Type | Individual
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Provider Name | JONATHAN MITCHELMORE LCSW
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Gender | Male
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Dates
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Enumeration Date | 08/23/2011
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Last Update Date | 09/03/2025
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Provider Practice Location Address
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Address Line | 100 S ELLSWORTH AVE STE 802
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City | SAN MATEO
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State | CA
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Zip | 94401-3926
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Country | US
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Telephone | 650-539-8042
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Fax |
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Provider Business Mailing Address
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Address Line | 1235 MISSION ST FL 2
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City | SAN FRANCISCO
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State | CA
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Zip | 94103-2705
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCSW79318
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License Number State | CA
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