Provider Demographics
NPI:1669063855
Name:MINCEY, JASON THOMAS (LCSW)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:THOMAS
Last Name:MINCEY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 OLD MAMARONECK RD APT 6I
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10605-1723
Mailing Address - Country:US
Mailing Address - Phone:914-804-7841
Mailing Address - Fax:
Practice Address - Street 1:2 OLD MAMARONECK RD APT 6I
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10605-1723
Practice Address - Country:US
Practice Address - Phone:914-804-7841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-29
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0872161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical