Provider Demographics
NPI:1598870933
Name:MINTZ, SUE P (DLCSW)
Entity Type:Individual
Prefix:MRS
First Name:SUE
Middle Name:P
Last Name:MINTZ
Suffix:
Gender:F
Credentials:DLCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 S CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-5402
Mailing Address - Country:US
Mailing Address - Phone:516-872-9698
Mailing Address - Fax:516-872-8758
Practice Address - Street 1:73 S CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-5402
Practice Address - Country:US
Practice Address - Phone:516-872-9698
Practice Address - Fax:516-872-8758
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRO45181-1101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)