Provider Demographics
NPI:1992279061
Name:MINTZ, ADAM (LMHC)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:MINTZ
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 BAXTER ST
Mailing Address - Street 2:
Mailing Address - City:WESTBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01581-2003
Mailing Address - Country:US
Mailing Address - Phone:781-249-7795
Mailing Address - Fax:
Practice Address - Street 1:45 MAIN ST STE 403
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:MA
Practice Address - Zip Code:01749-2166
Practice Address - Country:US
Practice Address - Phone:508-245-7760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-11
Last Update Date:2019-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6128101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health