Provider Demographics
NPI:1619028479
Name:MINTON, JUDITH MARION (PHD)
Entity Type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:MARION
Last Name:MINTON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:JUDITH
Other - Middle Name:
Other - Last Name:HABER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:333 EAST 34TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016
Mailing Address - Country:US
Mailing Address - Phone:212-396-8920
Mailing Address - Fax:
Practice Address - Street 1:330 EAST 70TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021
Practice Address - Country:US
Practice Address - Phone:212-396-8920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0050661103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist