Provider Demographics
NPI:1437633906
Name:DINKINS, EBONI (LMT, MMT)
Entity Type:Individual
Prefix:
First Name:EBONI
Middle Name:
Last Name:DINKINS
Suffix:
Gender:F
Credentials:LMT, MMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 YOUNG ST FL 1
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-2953
Mailing Address - Country:US
Mailing Address - Phone:203-654-1964
Mailing Address - Fax:
Practice Address - Street 1:14 YOUNG ST FL 1
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-2953
Practice Address - Country:US
Practice Address - Phone:475-355-7807
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-20
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT009790225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist