Basic Information
Provider Information
NPI: 1518968999
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MITCHELL
FirstName: SHIRLEY
MiddleName: M
NamePrefix:  
NameSuffix:  
Credential: LCSW
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 4 ALLEGHENY CTR FL 8
Address2:  
City: PITTSBURGH
State: PA
PostalCode: 152125255
CountryCode: US
TelephoneNumber: 4123304000
FaxNumber: 4123304366
Practice Location
Address1: 4 ALLEGHENY CTR FL 8
Address2:  
City: PITTSBURGH
State: PA
PostalCode: 152125255
CountryCode: US
TelephoneNumber: 4123304000
FaxNumber: 4123304366
Other Information
ProviderEnumerationDate: 08/09/2005
LastUpdateDate: 10/09/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 10/09/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1041C0700XSW007605LPAY Behavioral Health & Social Service ProvidersSocial WorkerClinical

No ID Information.


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