Basic Information
| Provider Information | |||||||||
| NPI: | 1649339763 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MITCHELL | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MA LMHC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5 HANCOCK RD | ||||||||
| Address2: | |||||||||
| City: | WINDHAM | ||||||||
| State: | NH | ||||||||
| PostalCode: | 03087 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6034320324 | ||||||||
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| Practice Location | |||||||||
| Address1: | 60 ISLAND STREET | ||||||||
| Address2: | |||||||||
| City: | LAWRENCE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01840 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9786873700 | ||||||||
| FaxNumber: | 4259282856 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/06/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 3980 | MA | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.