Provider Demographics
NPI:1427493063
Name:MITCHELL, CLARE EILEEN
Entity type:Individual
Prefix:
First Name:CLARE
Middle Name:EILEEN
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 ROSEMARY ST STE C
Mailing Address - Street 2:
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02494-3259
Mailing Address - Country:US
Mailing Address - Phone:617-400-5305
Mailing Address - Fax:
Practice Address - Street 1:145 ROSEMARY ST STE C
Practice Address - Street 2:
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02494-3259
Practice Address - Country:US
Practice Address - Phone:781-400-5305
Practice Address - Fax:781-400-5839
Is Sole Proprietor?:No
Enumeration Date:2013-05-09
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
222Q00000X
MA77518235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist