Provider Demographics
NPI:1841641743
Name:BERMANSOHN, LAINE CECILY HARTWELL (LPCC)
Entity type:Individual
Prefix:MS
First Name:LAINE
Middle Name:CECILY HARTWELL
Last Name:BERMANSOHN
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:LAINE
Other - Middle Name:CECILY HARTWELL
Other - Last Name:EPP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5354 PARKDALE DRIVE 2ND FLOOR
Mailing Address - Street 2:
Mailing Address - City:ST. LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416
Mailing Address - Country:US
Mailing Address - Phone:952-652-7452
Mailing Address - Fax:952-746-5962
Practice Address - Street 1:5354 PARKDALE DRIVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:ST. LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416
Practice Address - Country:US
Practice Address - Phone:651-645-5323
Practice Address - Fax:952-746-5962
Is Sole Proprietor?:No
Enumeration Date:2016-06-22
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN01907101YM0800X
101YM0800X
MNCC01900103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health