Provider Demographics
NPI:1891085593
Name:MITCHELL, DANIELLE (LICSW)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 MAZARIN ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01151-2118
Mailing Address - Country:US
Mailing Address - Phone:413-388-5279
Mailing Address - Fax:
Practice Address - Street 1:3651 FAU BLVD STE 400
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-6489
Practice Address - Country:US
Practice Address - Phone:833-919-2797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-14
Last Update Date:2024-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1278301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
M18463OtherBLUE CROSS/BLUE SHIELD
MA1303295Medicaid
MA1307576Medicaid
MA1303295Medicaid