Provider Demographics
NPI:1497824809
Name:MINRATH, MARILYN FRANCES (PH,D,)
Entity Type:Individual
Prefix:DR
First Name:MARILYN
Middle Name:FRANCES
Last Name:MINRATH
Suffix:
Gender:F
Credentials:PH,D,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 FAULCONER DR STE 2D
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22903-4981
Mailing Address - Country:US
Mailing Address - Phone:434-296-6462
Mailing Address - Fax:434-296-6462
Practice Address - Street 1:505 FAULCONER DR STE 2D
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-4981
Practice Address - Country:US
Practice Address - Phone:434-296-6462
Practice Address - Fax:434-296-6462
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001047868103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical