MEDICARE: MS. KATHERINE 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	104100000X	Social Worker	0424691	NY

General Provider Information

NPI Number	:	1376553362
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATHERINE MITCHELL LCSW

Provider Business Mailing Address
First Line	:	PO BOX 3214
Second Line	:
City	:	SAG HARBOR
State	:	NY
Zip	:	11963-0407
Country	:	US
Telephone Number	:	631-481-6550
Fax Number	:

Provider Business Practice Location Address
First Line	:	3297 NOYAC RD
Second Line	:
City	:	SAG HARBOR
State	:	NY
Zip	:	11963-1942
Country	:	US
Telephone Number	:	631-481-6550
Fax Number	:

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

Provider Enumeration Date	:	08/09/2006
Last Update Date	:	04/14/2014

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