Provider Demographics
NPI:1689363400
Name:NOTAR, DAVID ANTHONY
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:ANTHONY
Last Name:NOTAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:DAVID
Other - Middle Name:ANTHONY
Other - Last Name:NOTAR-CARLSTROM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:525 PORTLAND AVE # MC963
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55415-1533
Mailing Address - Country:US
Mailing Address - Phone:612-596-1223
Mailing Address - Fax:612-677-6357
Practice Address - Street 1:525 PORTLAND AVE # MC963
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55415-1533
Practice Address - Country:US
Practice Address - Phone:612-596-1223
Practice Address - Fax:612-677-6357
Is Sole Proprietor?:No
Enumeration Date:2023-05-08
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3587101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health