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General NPI Number Information
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NPI Number | 1205974474
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Entity Type | Individual
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Provider Name | ANTHONY R MINA M.ED.
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Gender | Male
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Dates
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Enumeration Date | 02/01/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1450 EAST BOOT ROAD SUITE 500D
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City | WEST CHESTER
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State | PA
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Zip | 19380-5926
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Country | US
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Telephone | 610-692-5828
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Fax | 610-431-9971
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Provider Business Mailing Address
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Address Line | 1450 EAST BOOT ROAD SUITE 500D
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City | WEST CHESTER
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State | PA
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Zip | 19380-5926
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Country | US
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Telephone | 610-692-5828
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Fax | 610-431-9971
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PS004075L
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License Number State | PA
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