MEDICARE: NOEL MITCHELL LCSW

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	CW020760	PA

General Provider Information

NPI Number	:	1215538657
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NOEL MITCHELL LCSW

Provider Business Mailing Address
First Line	:	PO BOX 40201
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19106-0201
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	410 MEMPHIS ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19125-2642
Country	:	US
Telephone Number	:	267-721-2470
Fax Number	:

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

Provider Enumeration Date	:	11/03/2020
Last Update Date	:	11/03/2020

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