Provider Demographics
NPI:1104300706
Name:GOLIN, MINDY ILENE (MA)
Entity type:Individual
Prefix:MRS
First Name:MINDY
Middle Name:ILENE
Last Name:GOLIN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 ASPEN DR
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-1432
Mailing Address - Country:US
Mailing Address - Phone:516-330-0338
Mailing Address - Fax:
Practice Address - Street 1:333 BLOOMFIELD AVE STE 102
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:NJ
Practice Address - Zip Code:07006-5105
Practice Address - Country:US
Practice Address - Phone:646-300-5689
Practice Address - Fax:201-488-5556
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-19
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00288900235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist