MEDICARE: ERICA SYLVIA MITCHELL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	12885913-3501	UT
2	1041C0700X	Clinical Social Worker	114509	TX
3	1041C0700X	Clinical Social Worker	SW22260	FL
4	1041C0700X	Clinical Social Worker	97280	CA

General Provider Information

NPI Number	:	1063043115
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERICA SYLVIA MITCHELL

Provider Business Mailing Address
First Line	:	1725 E BROAD ST UNIT 4031
Second Line	:
City	:	MANSFIELD
State	:	TX
Zip	:	76063-1431
Country	:	US
Telephone Number	:	510-691-7171
Fax Number	:

Provider Business Practice Location Address
First Line	:	1725 E BROAD ST UNIT 4031
Second Line	:
City	:	MANSFIELD
State	:	TX
Zip	:	76063-1431
Country	:	US
Telephone Number	:	510-691-7171
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/28/2020
Last Update Date	:	04/23/2026

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