Provider Demographics
NPI:1922376961
Name:BRIAN E STAWARZ LP LMFT LLC
Entity Type:Organization
Organization Name:BRIAN E STAWARZ LP LMFT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:EDMUND
Authorized Official - Last Name:STAWARZ
Authorized Official - Suffix:
Authorized Official - Credentials:LP, LMFT
Authorized Official - Phone:651-247-0723
Mailing Address - Street 1:774 LOWER COLONIAL DR
Mailing Address - Street 2:
Mailing Address - City:MENDOTA HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55118-2712
Mailing Address - Country:US
Mailing Address - Phone:651-554-9154
Mailing Address - Fax:
Practice Address - Street 1:100 W 46TH ST STE 2C
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55419-4950
Practice Address - Country:US
Practice Address - Phone:651-247-0723
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-05
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN305472100Medicaid