Justin Mink, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LCSW88990 Issued in CA

Practice address

13101 W Washington Blvd Ste 226
Los Angeles, CA 90066-8128

Phone

(424) 216-8404

NPI assigned

Mar 6, 2018

Reactivated

Jul 8, 2024

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1520294400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723680000000",
    "number": "1902308877",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13101 W WASHINGTON BLVD STE 226",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900668128",
            "telephone_number": "424-216-8404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13101 W WASHINGTON BLVD STE 226",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900668128",
            "telephone_number": "424-216-8404"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MINK",
        "first_name": "JUSTIN",
        "name_prefix": "Mr.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-03-06",
        "last_updated": "2024-08-15",
        "certification_date": "2024-08-14",
        "deactivation_date": "2024-04-23",
        "reactivation_date": "2024-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "LCSW88990",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Margo Minissian, ACNP, APRN-BC, MSN,
• Jessica Minjares Diaz
• Dorthyann Lovette Minjarez I
• Manuel Minjarez
• Diane Leslie Mink, PHD
• Katherine Santulli Mink
• Wilson Mink
• Jay Minko
• Christopher Minnick
• Karen Marie Minns

• Clinical Social Worker in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.