Provider Demographics
NPI:1225010788
Name:DIMOND, TERI (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:TERI
Middle Name:
Last Name:DIMOND
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 LOGAN AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55403-2842
Mailing Address - Country:US
Mailing Address - Phone:952-608-8403
Mailing Address - Fax:612-861-7589
Practice Address - Street 1:6701 PENN AVE S
Practice Address - Street 2:SUITE 301
Practice Address - City:RICHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55423-2093
Practice Address - Country:US
Practice Address - Phone:952-608-8403
Practice Address - Fax:612-861-7589
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN088791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical