Provider Demographics
NPI:1073560728
Name:MINKIN, ALAN L (LMHC, LCDCS)
Entity Type:Individual
Prefix:MR
First Name:ALAN
Middle Name:L
Last Name:MINKIN
Suffix:
Gender:M
Credentials:LMHC, LCDCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 SEAPOWET AVE
Mailing Address - Street 2:
Mailing Address - City:TIVERTON
Mailing Address - State:RI
Mailing Address - Zip Code:02878-4815
Mailing Address - Country:US
Mailing Address - Phone:401-624-3703
Mailing Address - Fax:
Practice Address - Street 1:75 SEAPOWET AVE
Practice Address - Street 2:
Practice Address - City:TIVERTON
Practice Address - State:RI
Practice Address - Zip Code:02878-4815
Practice Address - Country:US
Practice Address - Phone:401-624-3703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-28
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMHC00261101YM0800X
RILCDCS00005101YA0400X
MA4927101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)