MEDICARE: RICHARD S. MITCHELL PH.D.

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	103TC1900X	Counseling Psychologist	396	MA
2	103TB0200X	Cognitive & Behavioral Psychologist	00396	MA
3	103TC2200X	Clinical Child & Adolescent Psychologist	00396	MA
4	103TF0000X	Family Psychologist	396	MA
5	103TH0100X	Health Service Psychologist	396	MA
6	103TM1800X	Intellectual & Developmental Disabilities Psychologist	396	MA
7	103TA0700X	Adult Development & Aging Psychologist	00396	MA
8	103T00000X	Psychologist	00396	MA
9	103TC0700X	Clinical Psychologist	00396	MA
10	103TA0400X	Addiction (Substance Use Disorder) Psychologist	00396	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477551547
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD S. MITCHELL PH.D.

Provider Business Mailing Address
First Line	:	15 SHIRLEY AVE
Second Line	:
City	:	DENNIS PORT
State	:	MA
Zip	:	02639-2443
Country	:	US
Telephone Number	:	508-394-8677
Fax Number	:	508-394-1180

Provider Business Practice Location Address
First Line	:	15 SHIRLEY AVENUE
Second Line	:
City	:	DENNIS PORT
State	:	MA
Zip	:	02639-5590
Country	:	US
Telephone Number	:	508-394-8677
Fax Number	:	508-394-1180

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

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	04/08/2024

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