Provider Demographics
NPI:1386030385
Name:MINTZ, ARIEL
Entity Type:Individual
Prefix:
First Name:ARIEL
Middle Name:
Last Name:MINTZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25101 CHAGRIN BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5694
Mailing Address - Country:US
Mailing Address - Phone:216-831-6611
Mailing Address - Fax:
Practice Address - Street 1:25101 CHAGRIN BLVD STE 100
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5694
Practice Address - Country:US
Practice Address - Phone:216-831-6611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-07
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.1344922084P0800X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program