Provider Demographics
NPI:1760445076
Name:SALITERMAN, BEKAH (LICSW)
Entity Type:Individual
Prefix:
First Name:BEKAH
Middle Name:
Last Name:SALITERMAN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2649 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407
Mailing Address - Country:US
Mailing Address - Phone:612-676-1604
Mailing Address - Fax:612-379-8235
Practice Address - Street 1:60 E MARIE AVE
Practice Address - Street 2:SUITE 119
Practice Address - City:WEST ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55118
Practice Address - Country:US
Practice Address - Phone:612-676-1604
Practice Address - Fax:651-552-9874
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-08
Last Update Date:2008-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN158861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
153415700OtherMEDICAL ASSISTANCE
MN153415700Medicaid