Provider Demographics
NPI:1386800720
Name:MARSHA MINKIN PSY D P A
Entity type:Organization
Organization Name:MARSHA MINKIN PSY D P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARSHA
Authorized Official - Middle Name:
Authorized Official - Last Name:MINKIN
Authorized Official - Suffix:
Authorized Official - Credentials:PSY D P A
Authorized Official - Phone:954-983-7457
Mailing Address - Street 1:5700 HOLLYWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-6350
Mailing Address - Country:US
Mailing Address - Phone:954-983-7457
Mailing Address - Fax:954-983-2963
Practice Address - Street 1:5700 HOLLYWOOD BLVD
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-6350
Practice Address - Country:US
Practice Address - Phone:954-983-7457
Practice Address - Fax:954-983-2963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-05
Last Update Date:2010-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5829302R00000X, 305R00000X, 305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
No302R00000XManaged Care OrganizationsHealth Maintenance Organization
No305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBI902AMedicare PIN