Provider Demographics
NPI:1497106959
Name:MINKIN, MARC HIGGER
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:HIGGER
Last Name:MINKIN
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 1:10711 PEARSON ST
Mailing Address - Street 2:
Mailing Address - City:KENSINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20895-2230
Mailing Address - Country:US
Mailing Address - Phone:443-452-8088
Mailing Address - Fax:
Practice Address - Street 1:10711 PEARSON ST
Practice Address - Street 2:
Practice Address - City:KENSINGTON
Practice Address - State:MD
Practice Address - Zip Code:20895-2230
Practice Address - Country:US
Practice Address - Phone:443-452-8088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-27
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD172541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical