Provider Demographics
NPI:1770794273
Name:SHEMTOV, MINDY (MSW)
Entity type:Individual
Prefix:
First Name:MINDY
Middle Name:
Last Name:SHEMTOV
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8208 LAGOON DR
Mailing Address - Street 2:
Mailing Address - City:MARGATE CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08402-1619
Mailing Address - Country:US
Mailing Address - Phone:609-484-1133
Mailing Address - Fax:
Practice Address - Street 1:8208 LAGOON DR
Practice Address - Street 2:
Practice Address - City:MARGATE CITY
Practice Address - State:NJ
Practice Address - Zip Code:08402-1619
Practice Address - Country:US
Practice Address - Phone:609-484-1133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0017663Medicaid