Provider Demographics
NPI:1518333475
Name:JOSEPHINE S. MINARDO, PSY.D., P.C.
Entity Type:Organization
Organization Name:JOSEPHINE S. MINARDO, PSY.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPHINE
Authorized Official - Middle Name:S
Authorized Official - Last Name:MINARDO
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:914-831-7969
Mailing Address - Street 1:171 E POST RD
Mailing Address - Street 2:SUITE #310
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10601-4965
Mailing Address - Country:US
Mailing Address - Phone:914-831-7969
Mailing Address - Fax:
Practice Address - Street 1:171 E POST RD
Practice Address - Street 2:SUITE #310
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601-4965
Practice Address - Country:US
Practice Address - Phone:914-831-7969
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-14
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016545103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA300091095OtherMEDICARE PTAN