Provider Demographics
NPI:1336987148
Name:TRAN, MINDY
Entity type:Individual
Prefix:
First Name:MINDY
Middle Name:
Last Name:TRAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 MONTVALE AVE STE 218
Mailing Address - Street 2:
Mailing Address - City:STONEHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02180-2446
Mailing Address - Country:US
Mailing Address - Phone:781-537-6610
Mailing Address - Fax:781-218-9177
Practice Address - Street 1:38 MONTVALE AVE STE 218
Practice Address - Street 2:
Practice Address - City:STONEHAM
Practice Address - State:MA
Practice Address - Zip Code:02180-2446
Practice Address - Country:US
Practice Address - Phone:781-537-6610
Practice Address - Fax:781-218-9177
Is Sole Proprietor?:No
Enumeration Date:2024-07-16
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALABA10000816103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst