MEDICARE: DR. CRISTELA MARIA MITCHELL PHD, 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	0904014613	VA

General Provider Information

NPI Number	:	1851129555
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CRISTELA MARIA MITCHELL PHD, LCSW

Provider Business Mailing Address
First Line	:	214 OCARINA ST SW
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32908-1317
Country	:	US
Telephone Number	:	586-350-7131
Fax Number	:

Provider Business Practice Location Address
First Line	:	214 OCARINA ST SW
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32908-1317
Country	:	US
Telephone Number	:	586-350-7131
Fax Number	:

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

Provider Enumeration Date	:	07/24/2024
Last Update Date	:	07/24/2024

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