Provider Demographics
NPI:1053348227
Name:MITCHELL, WILLIAM MORRIS JR (ED D)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:MORRIS
Last Name:MITCHELL
Suffix:JR
Gender:M
Credentials:ED D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PEPPERELL
Mailing Address - State:MA
Mailing Address - Zip Code:01463-1615
Mailing Address - Country:US
Mailing Address - Phone:978-433-8947
Mailing Address - Fax:
Practice Address - Street 1:227 CONCORD AVE
Practice Address - Street 2:E2
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-1334
Practice Address - Country:US
Practice Address - Phone:978-433-8947
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2606103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical