Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PS005301L | PA |
Y | 103TC0700X | Clinical Psychologist | PS005301L | PA |
NPI | 1003866559 |
---|---|
Provider Name | Dr. Ellen L Mitchell |
First Address | Philadelphia, PA 19144-3823 |
Second Address | Philadelphia, PA 19144-3823 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0409212000 | BC/BS PERSONAL CHOICE ETC (01) | PA |
MI587330 | NATIONAL BILLING NUMBER (01) | PA |