Provider Demographics
NPI:1447508791
Name:MITCHELL, JESSICA DIANE (PHD)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:DIANE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2083 COUNTY ROAD 25
Mailing Address - Street 2:
Mailing Address - City:PHELPS
Mailing Address - State:NY
Mailing Address - Zip Code:14532-9609
Mailing Address - Country:US
Mailing Address - Phone:401-243-7154
Mailing Address - Fax:
Practice Address - Street 1:3019 COUNTY COMPLEX DR
Practice Address - Street 2:
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:14424-9505
Practice Address - Country:US
Practice Address - Phone:585-396-4363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-16
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent