MEDICARE: MR. ZELIK S MINTZ L.C.S,W,, L.P.

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	102L00000X	Psychoanalyst	000600	NY
2	1041C0700X	Clinical Social Worker	R051279	NY

General Provider Information

NPI Number	:	1326266610
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ZELIK S MINTZ L.C.S,W,, L.P.

Provider Business Mailing Address
First Line	:	31 E 12TH ST
Second Line	:	SUITE 1E
City	:	NEW YORK
State	:	NY
Zip	:	10003-4623
Country	:	US
Telephone Number	:	212-375-1303
Fax Number	:

Provider Business Practice Location Address
First Line	:	31 E 12TH ST
Second Line	:	SUITE 1E
City	:	NEW YORK
State	:	NY
Zip	:	10003-4623
Country	:	US
Telephone Number	:	212-375-1303
Fax Number	:

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

Provider Enumeration Date	:	04/23/2007
Last Update Date	:	09/22/2009

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Directions to “ MR. ZELIK S MINTZ L.C.S,W,, L.P.” Practice Location

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