Provider Demographics
NPI:1013187962
Name:MINKIN, INGRID MILENA
Entity Type:Individual
Prefix:
First Name:INGRID
Middle Name:MILENA
Last Name:MINKIN
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 1:200 WINCHESTER CIR
Mailing Address - Street 2:SUITE E-21
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-1829
Mailing Address - Country:US
Mailing Address - Phone:408-309-1998
Mailing Address - Fax:
Practice Address - Street 1:160 E VIRGINIA ST
Practice Address - Street 2:STE # 280
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112-5857
Practice Address - Country:US
Practice Address - Phone:408-998-1535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-06
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health