Provider Demographics
NPI:1760761092
Name:ATKIN, MINDY (LCATATR-BC)
Entity Type:Individual
Prefix:
First Name:MINDY
Middle Name:
Last Name:ATKIN
Suffix:
Gender:F
Credentials:LCATATR-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 GLEN ST
Mailing Address - Street 2:
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542-2737
Mailing Address - Country:US
Mailing Address - Phone:516-998-5011
Mailing Address - Fax:
Practice Address - Street 1:100 GLEN ST
Practice Address - Street 2:
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-2737
Practice Address - Country:US
Practice Address - Phone:516-998-5011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-04
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001306-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health