Marissa Mitchell, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Practice address

306 N Larkin Ave
Joliet, IL 60435-6698

Phone

(815) 744-5560

Fax

(708) 843-0401

NPI assigned

Jul 31, 2019

Last updated

Jul 31, 2019By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Intentional Fulfillment Counseling L.L.C.

  • Mental Health Counselor
  • Romeoville, IL
  • NPI 1134715238

  Single Specialty

  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1564531200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1564531200000",
    "number": "1457905176",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "503 LEMOYNE AVE",
            "city": "ROMEOVILLE",
            "state": "IL",
            "postal_code": "60446",
            "telephone_number": "708-790-0469"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "306 N LARKIN AVE",
            "city": "JOLIET",
            "state": "IL",
            "postal_code": "604356698",
            "telephone_number": "815-744-5560",
            "fax_number": "708-843-0401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MITCHELL",
        "first_name": "MARISSA",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-07-31",
        "last_updated": "2019-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mindful Living Center Illinois Chicago NW LLC
• Mindful Living Center Illinois Joliet LLC
• Marissa Minturn, OT
• Rodolfo Mireles, LCPC
• Inna Mirsky, PSYD
• Shantese Sayana Mitchell
• Thomas Mittler Sr.
• Ryan Miyashiro, DPT
• MNM Home MD Inc.
• Casey A Moauro, MD

• Clinical Social Worker in Joliet, IL
• Providers in Joliet, IL by specialty
• Clinical Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.