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General NPI Number Information
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NPI Number | 1699097162
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Entity Type | Individual
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Provider Name | LAURA THOMPSON MITCHELL LSW
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Gender | Female
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Dates
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Enumeration Date | 02/24/2010
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Last Update Date | 11/11/2013
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Provider Practice Location Address
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Address Line | 1 BAY AVE
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City | MONTCLAIR
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State | NJ
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Zip | 07042-4837
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Country | US
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Telephone | 973-429-6141
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Fax |
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Provider Business Mailing Address
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Address Line | 127 MIDLAND AVE #2
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City | MONTCLAIR
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State | NJ
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Zip | 07042-2959
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Country | US
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Telephone | 718-344-2665
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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 | 73 081118
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 44SL05779600
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License Number State | NJ
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