Provider Demographics
NPI:1801176276
Name:MINNITI, NANCY LARA (PSYD)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:LARA
Last Name:MINNITI
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Gender:F
Credentials:PSYD
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Mailing Address - Street 1:3401 N BROAD ST
Mailing Address - Street 2:TEMPLE HOSPITAL PM&R, BASEMENT ROCK PAVILION
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19140-5103
Mailing Address - Country:US
Mailing Address - Phone:215-707-1580
Mailing Address - Fax:
Practice Address - Street 1:3401 N BROAD ST
Practice Address - Street 2:TEMPLE HOSPITAL PM&R, BASEMENT ROCK PAVILION
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19140-5103
Practice Address - Country:US
Practice Address - Phone:215-707-1580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-17
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAPS016659103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist