Provider Demographics
NPI:1205920352
Name:BERAN, DIANA (MS, LP)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:BERAN
Suffix:
Gender:F
Credentials:MS, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 WILLOWMERE DR
Mailing Address - Street 2:
Mailing Address - City:ZUMBROTA
Mailing Address - State:MN
Mailing Address - Zip Code:55992-1297
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2450 RIVERSIDE AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454-1450
Practice Address - Country:US
Practice Address - Phone:612-672-6999
Practice Address - Fax:612-672-2691
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP3979103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN170155000OtherMN CARE
MN129786OtherUCARE
MN62-41762OtherUBH
MN41-1546550OtherBHP
MNHP30456OtherHEALTHPARTNERS
MN112M2BEOtherBCBS