Provider Demographics
NPI:1295171528
Name:MINTZ, MICHELLE SUZANNE
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:SUZANNE
Last Name:MINTZ
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:MICHELLE
Other - Middle Name:SUZANNE
Other - Last Name:MINTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:303 5TH AVE RM 1403
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-6640
Mailing Address - Country:US
Mailing Address - Phone:917-846-8210
Mailing Address - Fax:
Practice Address - Street 1:303 5TH AVE RM 1403
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016
Practice Address - Country:US
Practice Address - Phone:917-846-8210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-14
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist