Provider Demographics
NPI:1962447573
Name:MINKOFF, DON A (LCSW)
Entity Type:Individual
Prefix:MR
First Name:DON
Middle Name:A
Last Name:MINKOFF
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 JEFFERSON AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18510-1630
Mailing Address - Country:US
Mailing Address - Phone:570-344-1186
Mailing Address - Fax:570-344-7641
Practice Address - Street 1:615 JEFFERSON AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18510-1630
Practice Address - Country:US
Practice Address - Phone:570-344-1186
Practice Address - Fax:570-344-7641
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0127551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
894295Medicare ID - Type Unspecified