Provider Demographics
NPI:1700815511
Name:MINKIN, MARSHA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MARSHA
Middle Name:
Last Name:MINKIN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5700 HOLLYWOOD BLVD.
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021
Mailing Address - Country:US
Mailing Address - Phone:954-983-7457
Mailing Address - Fax:954-983-2963
Practice Address - Street 1:5700 HOLLYWOOD BLVD.
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021
Practice Address - Country:US
Practice Address - Phone:954-983-7457
Practice Address - Fax:954-983-2963
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-02
Last Update Date:2010-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY5829103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL54409Medicare ID - Type UnspecifiedSTATE OF FLORIDA