Provider Demographics
NPI:1932223641
Name:MCNERNEY PSYCHOTHERAPY INC
Entity Type:Organization
Organization Name:MCNERNEY PSYCHOTHERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:FLORENCE
Authorized Official - Middle Name:K
Authorized Official - Last Name:MCNERNEY
Authorized Official - Suffix:
Authorized Official - Credentials:RN CNS LICSW
Authorized Official - Phone:651-482-0164
Mailing Address - Street 1:3585 LEXINGTON AVE N
Mailing Address - Street 2:#246
Mailing Address - City:ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55126-8055
Mailing Address - Country:US
Mailing Address - Phone:651-482-0164
Mailing Address - Fax:
Practice Address - Street 1:3585 LEXINGTON AVE N
Practice Address - Street 2:#246
Practice Address - City:ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55126-8055
Practice Address - Country:US
Practice Address - Phone:651-482-0164
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5461041C0700X
13122101363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Not Answered363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN111620OtherUCARE
MN111620OtherUCARE
=========OtherEIN