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NPI Code Detail

MEDICARE: DR. DORIAN MINTZER PH.D.

MEDICARE: DR. DORIAN MINTZER 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
1103T00000XPsychologist2812MA

General Provider Information

NPI Number : 1760461271
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DORIAN MINTZER PH.D.
Provider Business Mailing Address
First Line : 82 MARLBOROUGH ST
Second Line :
City : BOSTON
State : MA
Zip : 02116-2020
Country : US
Telephone Number : 617-267-0285
Fax Number : 617-232-0702
Provider Business Practice Location Address
First Line : 82 MARLBOROUGH ST
Second Line :
City : BOSTON
State : MA
Zip : 02116-2020
Country : US
Telephone Number : 617-267-0285
Fax Number : 617-232-0702
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/12/2006
Last Update Date : 03/25/2015

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