Provider Demographics
NPI:1144235029
Name:MINARDO, JOSEPHINE S (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPHINE
Middle Name:S
Last Name:MINARDO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 E POST RD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10601-4965
Mailing Address - Country:US
Mailing Address - Phone:914-434-5882
Mailing Address - Fax:
Practice Address - Street 1:10 FIELDSTONE DR
Practice Address - Street 2:UNIT #332
Practice Address - City:HARTSDALE
Practice Address - State:NY
Practice Address - Zip Code:10530-1577
Practice Address - Country:US
Practice Address - Phone:914-831-7969
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016545103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYVN0601Medicare ID - Type Unspecified