Provider Demographics
NPI:1922134071
Name:HAWTHORNE FAMILY SERVICES
Entity Type:Organization
Organization Name:HAWTHORNE FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PSYCHOLOGIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:K
Authorized Official - Last Name:VUCINOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:MS LP
Authorized Official - Phone:612-889-4291
Mailing Address - Street 1:80 HAMPSHIRE AVE N
Mailing Address - Street 2:
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55427-4923
Mailing Address - Country:US
Mailing Address - Phone:612-889-4291
Mailing Address - Fax:763-546-8189
Practice Address - Street 1:80 HAMPSHIRE AVE N
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55427-4923
Practice Address - Country:US
Practice Address - Phone:612-889-4291
Practice Address - Fax:763-546-8189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP1141103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN330J6VUOtherBLUECROSS
MN$$$$$$$$$OtherSOCIAL SECURITY
MN1700954005OtherNPI # INDIVIDUAL
MN62-57935OtherUNITED BEHAVIORAL HEALTH