| |
11224 86th Ave N Maple Grove MN 55369-4510 | |
(763) 400-7077 | |
(763) 400-7078 |
Full Name | |
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Speciality | Social Worker |
Location | 11224 86th Ave N, Maple Grove, Minnesota |
Authorized Official Name and Position | Margot Storti-marron (OWNER, PSYCHOTHERAPIST) |
Authorized Official Contact | 7634007077 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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16460 78th Ave N Maple Grove MN 55311 Ph: (763) 416-6350 | 11224 86th Ave N Maple Grove MN 55369-4510 Ph: (763) 400-7077 |
NPI Number | 1467975607 |
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Provider Enumeration Date | 07/19/2017 |
Last Update Date | 06/11/2019 |
Medicare PECOS PAC ID | 2567703317 |
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Medicare Enrollment ID | O20190404002471 |
Identifier | Type | State | Issuer |
---|---|---|---|
1467975607 | NPI | - | NPPES |
1528159860 | Other | NPI |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1041C0700X | Social Worker - Clinical | 06884 (Minnesota) | Primary |
Provider Name | Margot Elaine Storti-marron |
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Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1528159860 PECOS PAC ID: 4486979267 Enrollment ID: I20150219001556 |
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