Provider Demographics
NPI:1598062333
Name:KROLL SUTTON, MINDY ELLEN (LMSW)
Entity Type:Individual
Prefix:MS
First Name:MINDY
Middle Name:ELLEN
Last Name:KROLL SUTTON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MS
Other - First Name:MINDY
Other - Middle Name:ELLEN
Other - Last Name:KROLL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:215 E 95TH ST
Mailing Address - Street 2:APT. 30J
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-4077
Mailing Address - Country:US
Mailing Address - Phone:646-457-1002
Mailing Address - Fax:
Practice Address - Street 1:215 E 95TH ST
Practice Address - Street 2:APT. 30J
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-4077
Practice Address - Country:US
Practice Address - Phone:646-457-1002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-14
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY064617-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker