Provider Demographics
NPI:1376649020
Name:DINZEO, DELORES A (LP)
Entity type:Individual
Prefix:
First Name:DELORES
Middle Name:A
Last Name:DINZEO
Suffix:
Gender:F
Credentials:LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1772 SKILLMAN AVE W
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-5620
Mailing Address - Country:US
Mailing Address - Phone:651-647-1900
Mailing Address - Fax:
Practice Address - Street 1:1310 E HIGHWAY 96
Practice Address - Street 2:SUITE 200
Practice Address - City:WHITE BEAR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55110-3483
Practice Address - Country:US
Practice Address - Phone:651-426-3071
Practice Address - Fax:651-426-3095
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3582103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist