1851467898 NPI number — MR. JOHN R MITCHELL LICSW

Table of content: MR. JOHN R MITCHELL LICSW (NPI 1851467898)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851467898 NPI number — MR. JOHN R MITCHELL LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MITCHELL
Provider First Name:
JOHN
Provider Middle Name:
R
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LICSW
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1851467898
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 9506
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FALL RIVER
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02720
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-415-9171
Provider Business Mailing Address Fax Number:
508-674-4358

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
887 2ND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FALL RIVER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02721-1998
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-415-9171
Provider Business Practice Location Address Fax Number:
508-674-4358
Provider Enumeration Date:
11/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  1031868 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1892223 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 407153 . This is a "MAGELLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 21188-8 . This is a "BC BS OF RI" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 1034810 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1034810 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 23825 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1851578 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 185821 . This is a "VALUE OPTIONS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 7675509 . This is a "AETNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: P07592 . This is a "BC BS OF MA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com