Provider Demographics
NPI:1154563690
Name:MITCHELL, SUSAN B (LP)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:B
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:481 8TH AVE
Mailing Address - Street 2:SUITE 711
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-1809
Mailing Address - Country:US
Mailing Address - Phone:212-662-2049
Mailing Address - Fax:
Practice Address - Street 1:481 8TH AVE
Practice Address - Street 2:SUITE 711
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-1809
Practice Address - Country:US
Practice Address - Phone:212-662-2049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-30
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY19-000297102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst