Provider Demographics
NPI:1861815490
Name:LUNDBERG, BRITTA MARIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:BRITTA
Middle Name:MARIE
Last Name:LUNDBERG
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:BRITTA
Other - Middle Name:MARIE
Other - Last Name:TORGERSON, JABBAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4422 WHITE BEAR AVE N
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WHITE BEAR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55110-3475
Mailing Address - Country:US
Mailing Address - Phone:763-400-7837
Mailing Address - Fax:763-400-7444
Practice Address - Street 1:3900 NORTHWOODS DR
Practice Address - Street 2:
Practice Address - City:ARDEN HILLS
Practice Address - State:MN
Practice Address - Zip Code:55112-6966
Practice Address - Country:US
Practice Address - Phone:651-787-9600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-03
Last Update Date:2018-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3428-57103T00000X
MNGL0057103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist