Provider Demographics
NPI:1922869684
Name:JENKINS, MINDY BAIERA (LSW)
Entity Type:Individual
Prefix:
First Name:MINDY
Middle Name:BAIERA
Last Name:JENKINS
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1208 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:PA
Mailing Address - Zip Code:18612-3122
Mailing Address - Country:US
Mailing Address - Phone:570-760-6667
Mailing Address - Fax:
Practice Address - Street 1:1208 MARKET ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:PA
Practice Address - Zip Code:18612-3122
Practice Address - Country:US
Practice Address - Phone:570-760-6667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-19
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW140933104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker