Provider Demographics
NPI:1629319967
Name:CONVIE, MINDY (LCSW)
Entity Type:Individual
Prefix:
First Name:MINDY
Middle Name:
Last Name:CONVIE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 S MACQUESTEN PKWY STE 103
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10550-1733
Mailing Address - Country:US
Mailing Address - Phone:914-419-6201
Mailing Address - Fax:
Practice Address - Street 1:15 S MACQUESTEN PKWY STE 103
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10550-1733
Practice Address - Country:US
Practice Address - Phone:914-419-6201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-12
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY088740-1101Y00000X
NY0849331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor