Provider Demographics
NPI:1437295839
Name:NUMAN, BERENDINA MARLEEN (PHD LP)
Entity Type:Individual
Prefix:
First Name:BERENDINA
Middle Name:MARLEEN
Last Name:NUMAN
Suffix:
Gender:F
Credentials:PHD LP
Other - Prefix:DR
Other - First Name:INA
Other - Middle Name:M
Other - Last Name:NUMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:430 OAK GROVE ST
Mailing Address - Street 2:SUITE 230
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55403-3253
Mailing Address - Country:US
Mailing Address - Phone:612-333-1766
Mailing Address - Fax:952-475-1324
Practice Address - Street 1:430 OAK GROVE ST
Practice Address - Street 2:SUITE 230
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55403-3253
Practice Address - Country:US
Practice Address - Phone:612-333-1766
Practice Address - Fax:952-475-1324
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP 0955103TC0700X, 103TE1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TE1100XBehavioral Health & Social Service ProvidersPsychologistExercise & Sports
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN27-132-300-081OtherCHAMPUS
MN4114-7978OtherFEDERAL ID #-CCSM
MN865547200Medicaid
MN68N 680000120Medicare ID - Type UnspecifiedMENTAL HEALTH SERVICES
MN27-132-300-081OtherCHAMPUS