Provider Demographics
NPI:1316127137
Name:PAGE, MITCHELL KENNETH (DSW, ACSW,LCSW,BCD)
Entity type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:KENNETH
Last Name:PAGE
Suffix:
Gender:M
Credentials:DSW, ACSW,LCSW,BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 MARKET SQ STE 2
Mailing Address - Street 2:
Mailing Address - City:NEWINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06111-2929
Mailing Address - Country:US
Mailing Address - Phone:860-841-2559
Mailing Address - Fax:860-371-3488
Practice Address - Street 1:39 MARKET SQ STE 2
Practice Address - Street 2:
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111-2929
Practice Address - Country:US
Practice Address - Phone:860-841-2559
Practice Address - Fax:860-371-3488
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-08
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0020421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical