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520 Osborne Rd Ne, Ste 120 Fridley MN 55432-2718 | |
| (763) 236-4300 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Psychologist - Addiction (substance Use Disorder) |
| Location | 520 Osborne Rd Ne, Ste 120, Fridley, Minnesota |
| Authorized Official Name and Position | Dominica Tallarico (COO) |
| Authorized Official Contact | 6122222222 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 43 Mail Route 10585 Minneapolis MN 55440-0043 Ph: (612) 262-1166 | 520 Osborne Rd Ne, Ste 120 Fridley MN 55432-2718 Ph: (763) 236-4300 |
| NPI Number | 1083197214 |
|---|---|
| Provider Enumeration Date | 09/13/2018 |
| Last Update Date | 01/14/2025 |
| Certification Date | 01/14/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083197214 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TA0400X | Psychologist - Addiction (substance Use Disorder) | (* (Not Available)) | Primary |
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