Provider Demographics
NPI:1962530212
Name:MINTZER, LAWRENCE GEORGE (PHD)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:GEORGE
Last Name:MINTZER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 FLORAL VALE BLVD
Mailing Address - Street 2:
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067-5528
Mailing Address - Country:US
Mailing Address - Phone:215-860-8413
Mailing Address - Fax:215-860-8433
Practice Address - Street 1:608 FLORAL VALE BLVD
Practice Address - Street 2:
Practice Address - City:YARDLEY
Practice Address - State:PA
Practice Address - Zip Code:19067-5528
Practice Address - Country:US
Practice Address - Phone:215-860-8413
Practice Address - Fax:215-860-8433
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS004076L103TC0700X
NJ35SI00226700103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical