Provider Demographics
NPI:1235354101
Name:MINIKOWSKI, JAMES (LMFT)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:MINIKOWSKI
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 W TOWN ST
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-2112
Mailing Address - Country:US
Mailing Address - Phone:860-886-1508
Mailing Address - Fax:860-889-4606
Practice Address - Street 1:200 W TOWN ST
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-2112
Practice Address - Country:US
Practice Address - Phone:860-886-1508
Practice Address - Fax:860-889-4606
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000983106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist