Provider Demographics
NPI:1447595640
Name:MITTEL, CHANA BRACHA
Entity type:Individual
Prefix:MRS
First Name:CHANA
Middle Name:BRACHA
Last Name:MITTEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14733 76TH AVE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-3158
Mailing Address - Country:US
Mailing Address - Phone:646-543-9868
Mailing Address - Fax:718-715-7299
Practice Address - Street 1:293 DIVISION AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-7573
Practice Address - Country:US
Practice Address - Phone:718-302-3333
Practice Address - Fax:718-715-7299
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-29
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY087275104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker