Provider Demographics
NPI:1508348863
Name:MINGIN, GERALD D JR (PHD & PSYD)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:D
Last Name:MINGIN
Suffix:JR
Gender:M
Credentials:PHD & PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 EAYRESTOWN RD. SUITE A
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08055
Mailing Address - Country:US
Mailing Address - Phone:609-261-1022
Mailing Address - Fax:
Practice Address - Street 1:135 EAYRESTOWN RD. SUITE A
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:NJ
Practice Address - Zip Code:08055
Practice Address - Country:US
Practice Address - Phone:609-261-1022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-04
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ103TB0200X, 103TE1100X
NJTR183137002430541041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TE1100XBehavioral Health & Social Service ProvidersPsychologistExercise & Sports