Provider Demographics
NPI:1073789210
Name:MINK, CHRISTINE COPPOLA (PHD)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:COPPOLA
Last Name:MINK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 MOORE AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549-3127
Mailing Address - Country:US
Mailing Address - Phone:914-244-1467
Mailing Address - Fax:914-241-0521
Practice Address - Street 1:37 MOORE AVE
Practice Address - Street 2:
Practice Address - City:MOUNT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549-3127
Practice Address - Country:US
Practice Address - Phone:914-244-1467
Practice Address - Fax:914-241-0521
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011552-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical