Provider Demographics
NPI:1750485744
Name:DANSINGER, STUART SAMUEL (EDS)
Entity Type:Individual
Prefix:
First Name:STUART
Middle Name:SAMUEL
Last Name:DANSINGER
Suffix:
Gender:M
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12600 MARION LN W APT 103
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55305-1330
Mailing Address - Country:US
Mailing Address - Phone:612-385-6279
Mailing Address - Fax:
Practice Address - Street 1:12600 MARION LN W APT 103
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-1330
Practice Address - Country:US
Practice Address - Phone:612-385-6279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-11
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
MNLP1640103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN6121367OtherVBH
MN87726OtherUNITED BEHAVIORAL HEALTH
MN03338DAOtherBCBS
MN218845700Medicaid