Provider Demographics
NPI:1902186190
Name:MINKIN, DANIELLE R (MA, LPC, NCC, ATR-BC)
Entity Type:Individual
Prefix:MS
First Name:DANIELLE
Middle Name:R
Last Name:MINKIN
Suffix:
Gender:F
Credentials:MA, LPC, NCC, ATR-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 FAIRFIELD AVE STE 1C
Mailing Address - Street 2:
Mailing Address - City:WEST CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006-6415
Mailing Address - Country:US
Mailing Address - Phone:732-779-1966
Mailing Address - Fax:
Practice Address - Street 1:175 FAIRFIELD AVE STE 1C
Practice Address - Street 2:
Practice Address - City:WEST CALDWELL
Practice Address - State:NJ
Practice Address - Zip Code:07006-6415
Practice Address - Country:US
Practice Address - Phone:732-779-1966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-19
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00604600101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0023701OtherAGENCY PROVIDER MEDICAID #