Provider Demographics
NPI:1043019094
Name:MINSAVAGE, MAUREEN A
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:A
Last Name:MINSAVAGE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:480 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:NANTICOKE
Mailing Address - State:PA
Mailing Address - Zip Code:18634-2707
Mailing Address - Country:US
Mailing Address - Phone:570-301-8893
Mailing Address - Fax:
Practice Address - Street 1:118 MONAHAN AVE
Practice Address - Street 2:
Practice Address - City:DUNMORE
Practice Address - State:PA
Practice Address - Zip Code:18512-1700
Practice Address - Country:US
Practice Address - Phone:570-344-5327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-12
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)