Provider Demographics
NPI:1124143243
Name:MITCHELL, PATRICIA (PSY,D)
Entity type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:PSY,D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 CANDLE HILL RD
Mailing Address - Street 2:
Mailing Address - City:NEW FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06812-2411
Mailing Address - Country:US
Mailing Address - Phone:203-746-5179
Mailing Address - Fax:
Practice Address - Street 1:4 BERKSHIRE BLVD
Practice Address - Street 2:
Practice Address - City:BETHEL
Practice Address - State:CT
Practice Address - Zip Code:06801-1001
Practice Address - Country:US
Practice Address - Phone:203-826-3140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2017-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001825103G00000X, 103TC0700X
NY011912-1103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist