Provider Demographics
NPI:1871873299
Name:MITTEN, SASHA (LCSW)
Entity type:Individual
Prefix:MS
First Name:SASHA
Middle Name:
Last Name:MITTEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:SASHA
Other - Middle Name:D
Other - Last Name:VIRVO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:15 1ST ST
Mailing Address - Street 2:APT. 5
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-5141
Mailing Address - Country:US
Mailing Address - Phone:203-570-6510
Mailing Address - Fax:
Practice Address - Street 1:141 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-5113
Practice Address - Country:US
Practice Address - Phone:203-969-0802
Practice Address - Fax:203-316-9024
Is Sole Proprietor?:No
Enumeration Date:2011-08-17
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY720844541041C0700X
CT87961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical