1215139746 NPI number — MARY ANN S MARGRETTA DWYER LP LMFT

Table of content: MARY ANN S MARGRETTA DWYER LP LMFT (NPI 1215139746)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215139746 NPI number — MARY ANN S MARGRETTA DWYER LP LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DWYER
Provider First Name:
MARY ANN
Provider Middle Name:
S MARGRETTA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LP LMFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DWYER
Provider Other First Name:
S MARGRETTA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LP LMFT
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1215139746
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5115 EXCELSIOR BLVD
Provider Second Line Business Mailing Address:
449
Provider Business Mailing Address City Name:
MPLS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55416
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
612-920-5351
Provider Business Mailing Address Fax Number:
612-920-4485

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5115 EXCELSIOR BLVD
Provider Second Line Business Practice Location Address:
449
Provider Business Practice Location Address City Name:
MPLS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55416
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-920-5351
Provider Business Practice Location Address Fax Number:
612-920-4485
Provider Enumeration Date:
06/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  1229 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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