Provider Demographics
NPI:1063566917
Name:MINKIN, ANITA (CSW)
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:
Last Name:MINKIN
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:ANITA
Other - Middle Name:
Other - Last Name:BERKOFSKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:750 EAST AVE
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-6165
Mailing Address - Country:US
Mailing Address - Phone:401-457-5252
Mailing Address - Fax:401-316-0439
Practice Address - Street 1:750 EAST AVE
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-6165
Practice Address - Country:US
Practice Address - Phone:401-457-5252
Practice Address - Fax:401-316-0439
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1100261041C0700X
RI1SW012891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI308612OtherBLUE CROSS BLUE SHIELD
RI411510OtherBLUE CHIP
RI308612OtherBLUE CROSS BLUE SHIELD