Provider Demographics
NPI:1407650021
Name:MINCER, LSW, MIMI C
Entity type:Individual
Prefix:
First Name:MIMI
Middle Name:C
Last Name:MINCER, LSW
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 ARNDT AVE APT A19
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:NJ
Mailing Address - Zip Code:08075-4230
Mailing Address - Country:US
Mailing Address - Phone:609-309-2777
Mailing Address - Fax:
Practice Address - Street 1:4228 S BROAD ST
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08620-2105
Practice Address - Country:US
Practice Address - Phone:609-475-2560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-02
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06603800101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health