MEDICARE: ELIZABETH MITCHELL LMSW

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	104100000X	Social Worker	079466	NY

General Provider Information

NPI Number	:	1164756821
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH MITCHELL LMSW

Provider Business Mailing Address
First Line	:	279 MAIN ST
Second Line	:	SUITE 204
City	:	NEW PALTZ
State	:	NY
Zip	:	12561-1623
Country	:	US
Telephone Number	:	845-255-3046
Fax Number	:	845-255-0236

Provider Business Practice Location Address
First Line	:	6 HEALTHY WAY
Second Line	:
City	:	ELLENVILLE
State	:	NY
Zip	:	12428-5612
Country	:	US
Telephone Number	:	845-647-4500
Fax Number	:	845-364-7632

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

Provider Enumeration Date	:	09/29/2009
Last Update Date	:	10/06/2009

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