Provider Demographics
NPI:1447678354
Name:MINTZ, SHERI A (LCSW)
Entity type:Individual
Prefix:
First Name:SHERI
Middle Name:A
Last Name:MINTZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4217
Mailing Address - Street 2:
Mailing Address - City:EDWARDS
Mailing Address - State:CO
Mailing Address - Zip Code:81632-4217
Mailing Address - Country:US
Mailing Address - Phone:970-445-7779
Mailing Address - Fax:
Practice Address - Street 1:98 ASPEN RIDGE LANE
Practice Address - Street 2:
Practice Address - City:EDWARDS
Practice Address - State:CO
Practice Address - Zip Code:81632-4217
Practice Address - Country:US
Practice Address - Phone:970-445-7779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-29
Last Update Date:2014-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical