Provider Demographics
NPI:1568774305
Name:RYMER, MINERVA (CASAC-T)
Entity Type:Individual
Prefix:
First Name:MINERVA
Middle Name:
Last Name:RYMER
Suffix:
Gender:F
Credentials:CASAC-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2410 AMSTERDAM AVE
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-7320
Mailing Address - Country:US
Mailing Address - Phone:917-258-3698
Mailing Address - Fax:212-740-7065
Practice Address - Street 1:2410 AMSTERDAM AVE
Practice Address - Street 2:4TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-7320
Practice Address - Country:US
Practice Address - Phone:917-258-3698
Practice Address - Fax:212-740-7065
Is Sole Proprietor?:No
Enumeration Date:2010-07-09
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY24387-TRAINEE101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
24387OtherTRAINEE CERTIFICATION