Provider Demographics
NPI:1275228736
Name:BRINSON, LIANA ELENA
Entity Type:Individual
Prefix:
First Name:LIANA
Middle Name:ELENA
Last Name:BRINSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 N 4TH ST UNIT 515
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55401-1952
Mailing Address - Country:US
Mailing Address - Phone:508-740-7980
Mailing Address - Fax:
Practice Address - Street 1:43 SE MAIN ST STE 226
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55414-1094
Practice Address - Country:US
Practice Address - Phone:651-661-5218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-10
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN319221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical