Provider Demographics
NPI:1851467898
Name:MITCHELL, JOHN R (LICSW)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:R
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:LICSW
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 9506
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02720
Mailing Address - Country:US
Mailing Address - Phone:508-415-9171
Mailing Address - Fax:508-674-4358
Practice Address - Street 1:887 2ND ST
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02721-1998
Practice Address - Country:US
Practice Address - Phone:508-415-9171
Practice Address - Fax:508-674-4358
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2009-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10318681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1892223Medicaid
MA407153OtherMAGELLAN
RI21188-8OtherBC BS OF RI
MA1034810Medicaid
RI1034810Medicaid
MA23825Medicaid
MA1851578Medicaid
MA185821OtherVALUE OPTIONS
MA7675509OtherAETNA
MAP07592OtherBC BS OF MA
MA185821OtherVALUE OPTIONS