Basic Information
| Provider Information | |||||||||
| NPI: | 1871873299 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MITTEN | ||||||||
| FirstName: | SASHA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LCSW | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | VIRVO | ||||||||
| OtherFirstName: | SASHA | ||||||||
| OtherMiddleName: | D | ||||||||
| OtherNamePrefix: | MS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | LCSW | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 15 1ST ST | ||||||||
| Address2: | APT. 5 | ||||||||
| City: | STAMFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 069055141 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2035706510 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 141 FRANKLIN ST | ||||||||
| Address2: | |||||||||
| City: | STAMFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 069025113 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2039690802 | ||||||||
| FaxNumber: | 2033169024 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2011 | ||||||||
| LastUpdateDate: | 12/22/2016 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 72084454 | NY | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | 8796 | CT | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.