Provider Demographics
NPI:1639640543
Name:MINTZ, SHARI G (PHD)
Entity Type:Individual
Prefix:
First Name:SHARI
Middle Name:G
Last Name:MINTZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:SHARI
Other - Middle Name:GAIL
Other - Last Name:JAGER-HYMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:3535 MARKET ST STE 3036
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-3313
Mailing Address - Country:US
Mailing Address - Phone:215-746-3944
Mailing Address - Fax:
Practice Address - Street 1:3535 MARKET ST STE 3036
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-3313
Practice Address - Country:US
Practice Address - Phone:215-746-3944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-17
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS018438103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist