Provider Demographics
NPI:1326266610
Name:MINTZ, ZELIK S (LCS,W,, LP)
Entity Type:Individual
Prefix:MR
First Name:ZELIK
Middle Name:S
Last Name:MINTZ
Suffix:
Gender:M
Credentials:LCS,W,, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 E 12TH ST
Mailing Address - Street 2:SUITE 1E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-4623
Mailing Address - Country:US
Mailing Address - Phone:212-375-1303
Mailing Address - Fax:
Practice Address - Street 1:31 E 12TH ST
Practice Address - Street 2:SUITE 1E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-4623
Practice Address - Country:US
Practice Address - Phone:212-375-1303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000600102L00000X
NYR0512791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst