Provider Demographics
NPI:1801032388
Name:BORG, MINDY (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MINDY
Middle Name:
Last Name:BORG
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 1:212 CRANBERRY CT
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-8702
Mailing Address - Country:US
Mailing Address - Phone:631-454-4512
Mailing Address - Fax:
Practice Address - Street 1:212 CRANBERRY CT
Practice Address - Street 2:
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-8702
Practice Address - Country:US
Practice Address - Phone:631-454-4512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-05
Last Update Date:2009-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0533351104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker