Provider Demographics
NPI:1245706688
Name:MINTZ, ANIYAH R (MHA)
Entity type:Individual
Prefix:
First Name:ANIYAH
Middle Name:R
Last Name:MINTZ
Suffix:
Gender:F
Credentials:MHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 REAVILLE AVE # 1072
Mailing Address - Street 2:
Mailing Address - City:FLEMINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08822-1714
Mailing Address - Country:US
Mailing Address - Phone:973-860-8899
Mailing Address - Fax:
Practice Address - Street 1:17 REAVILLE AVE # 1072
Practice Address - Street 2:
Practice Address - City:FLEMINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08822-1714
Practice Address - Country:US
Practice Address - Phone:973-860-8899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-23
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJM45290467956882405300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes405300000XOther Service ProvidersPrevention ProfessionalGroup - Single Specialty