Provider Demographics
NPI:1922294081
Name:MINTZ, MARSHA LYNN (LMSW)
Entity Type:Individual
Prefix:
First Name:MARSHA
Middle Name:LYNN
Last Name:MINTZ
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 CENTRAL PARK W
Mailing Address - Street 2:8C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-7659
Mailing Address - Country:US
Mailing Address - Phone:212-580-6475
Mailing Address - Fax:
Practice Address - Street 1:320 CENTRAL PARK W
Practice Address - Street 2:8C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-7659
Practice Address - Country:US
Practice Address - Phone:212-580-6475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-21
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0495461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY049546OtherNYS LICENSE