Provider Demographics
NPI:1699153460
Name:MINTZ, GAVRIELLA (PSYD, MSED)
Entity type:Individual
Prefix:DR
First Name:GAVRIELLA
Middle Name:
Last Name:MINTZ
Suffix:
Gender:F
Credentials:PSYD, MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 OXFORD RD
Mailing Address - Street 2:
Mailing Address - City:NEW HARTFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13413-2660
Mailing Address - Country:US
Mailing Address - Phone:315-223-8889
Mailing Address - Fax:315-223-8890
Practice Address - Street 1:44 OXFORD RD
Practice Address - Street 2:
Practice Address - City:NEW HARTFORD
Practice Address - State:NY
Practice Address - Zip Code:13413-2660
Practice Address - Country:US
Practice Address - Phone:315-223-8889
Practice Address - Fax:315-223-8890
Is Sole Proprietor?:No
Enumeration Date:2015-05-13
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021091103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist