Provider Demographics
NPI:1093735490
Name:MOIDEEN, YASMINE (PHD, LP)
Entity Type:Individual
Prefix:DR
First Name:YASMINE
Middle Name:
Last Name:MOIDEEN
Suffix:
Gender:F
Credentials:PHD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 COUNTY ROAD E W
Mailing Address - Street 2:SUITE 230
Mailing Address - City:SHOREVIEW
Mailing Address - State:MN
Mailing Address - Zip Code:55126-8152
Mailing Address - Country:US
Mailing Address - Phone:651-484-0000
Mailing Address - Fax:651-484-1050
Practice Address - Street 1:1030 COUNTY ROAD E W
Practice Address - Street 2:SUITE 230
Practice Address - City:SHOREVIEW
Practice Address - State:MN
Practice Address - Zip Code:55126-8152
Practice Address - Country:US
Practice Address - Phone:651-484-0000
Practice Address - Fax:651-484-1050
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP 3742103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN190G8MOOtherBCBS
MN659677100Medicaid
MN61-50789OtherUBH
MN190G8MOOtherBCBS
MN659677100Medicare PIN
MN659677100Medicare Oscar/Certification