Provider Demographics
NPI:1730337668
Name:DR. L. MITCHELL & ASSOCIATES, PA
Entity type:Organization
Organization Name:DR. L. MITCHELL & ASSOCIATES, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:LORRAINE
Authorized Official - Middle Name:ADASSA
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LCSW, CTS
Authorized Official - Phone:305-439-6957
Mailing Address - Street 1:1265 NW 127TH ST
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33167-2204
Mailing Address - Country:US
Mailing Address - Phone:305-439-6957
Mailing Address - Fax:305-688-8765
Practice Address - Street 1:1265 NW 127TH ST
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33167-2204
Practice Address - Country:US
Practice Address - Phone:305-439-6957
Practice Address - Fax:305-688-8765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-04
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL768303100Medicaid