Provider Demographics
NPI:1780722470
Name:BREYER, MINDY WILLNER (PSYD)
Entity type:Individual
Prefix:DR
First Name:MINDY
Middle Name:WILLNER
Last Name:BREYER
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 1:717 N BEERS ST
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733-1524
Mailing Address - Country:US
Mailing Address - Phone:732-264-2440
Mailing Address - Fax:732-888-7767
Practice Address - Street 1:717 N BEERS ST
Practice Address - Street 2:SUITE 2B
Practice Address - City:HOLMDEL
Practice Address - State:NJ
Practice Address - Zip Code:07733-1524
Practice Address - Country:US
Practice Address - Phone:732-264-2440
Practice Address - Fax:732-888-7767
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNJ2685103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist