Provider Demographics
NPI:1558411181
Name:GIRARDEAU, STEVEN MARK (PSYD, LP)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:MARK
Last Name:GIRARDEAU
Suffix:
Gender:M
Credentials:PSYD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3005 JAMES AVE S STE 101
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-2533
Mailing Address - Country:US
Mailing Address - Phone:612-227-0244
Mailing Address - Fax:612-377-7501
Practice Address - Street 1:3005 JAMES AVE S STE 101
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-2533
Practice Address - Country:US
Practice Address - Phone:612-227-0244
Practice Address - Fax:612-377-7501
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MNLP 3715103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN370 G9GIOtherBLUE CROSS BLUE SHIELD MN
MN203229853 55408A0001OtherTRICARE PROVIDER NUMBER
MN62-46819OtherUBH PROVIDER ID