Provider Demographics
NPI:1487799631
Name:MITCHELL, RONALD A (PHD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:A
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3036
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-0274
Mailing Address - Country:US
Mailing Address - Phone:856-751-8700
Mailing Address - Fax:856-751-3520
Practice Address - Street 1:2003 LINCOLN DR W
Practice Address - Street 2:SUITE A
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-1529
Practice Address - Country:US
Practice Address - Phone:856-751-8700
Practice Address - Fax:856-751-3520
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S100298900103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1256665Medicaid
NJR33855Medicare UPIN