Provider Demographics
NPI:1275985178
Name:MINOCCHI, DENISE
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:MINOCCHI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10180 STATE ROUTE 212 NE
Mailing Address - Street 2:D
Mailing Address - City:BOLIVAR
Mailing Address - State:OH
Mailing Address - Zip Code:44612-8638
Mailing Address - Country:US
Mailing Address - Phone:330-340-4613
Mailing Address - Fax:
Practice Address - Street 1:919 2ND ST NE
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44704-1132
Practice Address - Country:US
Practice Address - Phone:330-454-7917
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-05
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health