Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PS017681 | PA |
Y | 103TC0700X | Clinical Psychologist | PS017681 | PA |
N | 103TR0400X | Rehabilitation Psychologist |
NPI | 1326473042 |
---|---|
Provider Name | Dr. Patrick Vincent Mitchell |
First Address | Philadelphia, PA 19130-2523 |
Second Address | Old Lyme, CT 06371-1534 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2013 |
Last Update Date | 30/03/2020 |