MEDICARE: DR. VINCENT A MINNITI PH.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	12979	NY
2	101YM0800X	Mental Health Counselor	000104	NY
3	101YP2500X	Professional Counselor	37PC00329700	NJ
4	103TC1900X	Counseling Psychologist
5	103TB0200X	Cognitive & Behavioral Psychologist

General Provider Information

NPI Number	:	1609993047
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VINCENT A MINNITI PH.D

Provider Business Mailing Address
First Line	:	1641 CHATFIELD PL
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32814-6625
Country	:	US
Telephone Number	:	908-399-0806
Fax Number	:

Provider Business Practice Location Address
First Line	:	1225 PARK AVE STE 1S
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10128-1758
Country	:	US
Telephone Number	:	908-212-1693
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/22/2007
Last Update Date	:	08/29/2024

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