Provider Demographics
NPI:1326165119
Name:BIDERMAN, REBECCA (PHD, LP)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:
Last Name:BIDERMAN
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 1:3100 W LAKE ST
Mailing Address - Street 2:SUITE 320
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55416-4510
Mailing Address - Country:US
Mailing Address - Phone:612-929-1899
Mailing Address - Fax:612-929-9006
Practice Address - Street 1:3100 W LAKE ST
Practice Address - Street 2:SUITE 320
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55416-4510
Practice Address - Country:US
Practice Address - Phone:612-929-1899
Practice Address - Fax:612-929-9006
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP 1620103T00000X
MNMFT 276106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN01447BIOtherBLUE CROSS BLUE SHIELD MN