Provider Demographics
NPI:1275105140
Name:MINDLIS, IRINA (PHD)
Entity type:Individual
Prefix:DR
First Name:IRINA
Middle Name:
Last Name:MINDLIS
Suffix:
Gender:
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1360 FULTON ST UNIT 470086
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11247-4234
Mailing Address - Country:US
Mailing Address - Phone:347-788-9467
Mailing Address - Fax:
Practice Address - Street 1:1360 FULTON ST UNIT 470086
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11247-4234
Practice Address - Country:US
Practice Address - Phone:347-788-9467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-12
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026864103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical