Provider Demographics
NPI:1518956960
Name:MILSTEIN, MINDY RYTERMAN (PHD PSYCHOLOGIST)
Entity Type:Individual
Prefix:DR
First Name:MINDY
Middle Name:RYTERMAN
Last Name:MILSTEIN
Suffix:
Gender:F
Credentials:PHD PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 502
Mailing Address - Street 2:
Mailing Address - City:NEW WINDSOR
Mailing Address - State:MD
Mailing Address - Zip Code:21776-0502
Mailing Address - Country:US
Mailing Address - Phone:410-635-8686
Mailing Address - Fax:
Practice Address - Street 1:1645 LIBERTY RD
Practice Address - Street 2:SUITE 104
Practice Address - City:ELDERSBURG
Practice Address - State:MD
Practice Address - Zip Code:21784-6521
Practice Address - Country:US
Practice Address - Phone:410-795-4764
Practice Address - Fax:410-795-4462
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-18
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD3563103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDR971Medicare UPIN
MDGP17Medicare UPIN