Provider Demographics
NPI:1003918541
Name:DAVIN, MINDY (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:MINDY
Middle Name:
Last Name:DAVIN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 SUNSET RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02474-8921
Mailing Address - Country:US
Mailing Address - Phone:781-646-0917
Mailing Address - Fax:781-721-2118
Practice Address - Street 1:573 MAIN ST
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:MA
Practice Address - Zip Code:01890-2900
Practice Address - Country:US
Practice Address - Phone:781-729-4010
Practice Address - Fax:781-721-2113
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1018803101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health