Provider Demographics
NPI:1861264277
Name:MITCHELL, MELISA NOEL (MSW, LSW)
Entity type:Individual
Prefix:
First Name:MELISA
Middle Name:NOEL
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7536 DICKENS PL
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19153-1311
Mailing Address - Country:US
Mailing Address - Phone:267-648-4358
Mailing Address - Fax:
Practice Address - Street 1:3210 CHESTNUT ST STE 201
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-5407
Practice Address - Country:US
Practice Address - Phone:215-895-1415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-30
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW136745261QM0801X, 261QS1000X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health