Provider Demographics
NPI:1598952996
Name:AURELIUS, ERIC RANDALL (MS LICSW CPRP)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:RANDALL
Last Name:AURELIUS
Suffix:
Gender:F
Credentials:MS LICSW CPRP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7850 RIVERDALE DR NW
Mailing Address - Street 2:SUITE C
Mailing Address - City:RAMSEY
Mailing Address - State:MN
Mailing Address - Zip Code:55303-7215
Mailing Address - Country:US
Mailing Address - Phone:763-427-2590
Mailing Address - Fax:763-427-2579
Practice Address - Street 1:7850 RIVERDALE DR NW
Practice Address - Street 2:SUITE C
Practice Address - City:RAMSEY
Practice Address - State:MN
Practice Address - Zip Code:55303-7215
Practice Address - Country:US
Practice Address - Phone:763-427-2590
Practice Address - Fax:763-427-2579
Is Sole Proprietor?:No
Enumeration Date:2007-09-28
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN12633104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker