Provider Demographics
NPI:1205974474
Name:MINA, ANTHONY R (MED)
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:R
Last Name:MINA
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1450 EAST BOOT ROAD
Mailing Address - Street 2:SUITE 500D
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19380-5926
Mailing Address - Country:US
Mailing Address - Phone:610-692-5828
Mailing Address - Fax:610-431-9971
Practice Address - Street 1:1450 EAST BOOT ROAD
Practice Address - Street 2:SUITE 500D
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-5926
Practice Address - Country:US
Practice Address - Phone:610-692-5828
Practice Address - Fax:610-431-9971
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS004075L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist