Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 00396 | MA |
N | 103T00000X | Psychologist | 00396 | MA |
N | 102L00000X | Psychologist | 396 | MA |
N | 103T00000X | Psychologist | 396 | MA |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 00396 | MA |
N | 103TA0700X | Adult Development & Aging Psychologist | 00396 | MA |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 00396 | MA |
N | 103G00000X | Clinical Psychologist | 00396 | MA |
N | 103TC0700X | Clinical Psychologist | 00396 | MA |
N | 103TC1900X | Counseling Psychologist | 396 | MA |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 00396 | MA |
N | 103TF0000X | Family Psychologist | 396 | MA |
N | 103TH0100X | Health Service | 396 | MA |
N | 103TM1800X | Intellectual & Developmental Disabilities | 396 | MA |
NPI | 1477551547 |
---|---|
Provider Name | Richard S. Mitchell |
First Address | Dennis Port, MA 02639-5590 |
Second Address | Dennis Port, MA 02639-5590 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0504793 | (05) | MA |