Individual
WILLIAM EDGEFIELD MITCHELL III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSY.D.
Contact information
Practice address
1595 ELMWOOD AVE STE 2, ROCHESTER, NY 14620-3602
(585) 465-5072
(585) 486-5077
Mailing address
1595 ELMWOOD AVE STE 2, ROCHESTER, NY 14620-3602
(585) 465-5072
(585) 486-5077
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
011107
NY
103T00000X
Psychologist
0111107
NY
103TC2200X
Clinical Child & Adolescent Psychologist
011107
NY
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
014003729
EXCELLUS
NY
05
—
06800011107
—
NY
01
—
103283EU
PREFERRED CARE
NY
01
—
3109089
VALUE OPTIONS
NY
01
—
EM
EXCELLUS
NY
Enumeration date
08/16/2006
Last updated
07/21/2022
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