Provider Demographics
NPI:1932668795
Name:INTERPERSONAL PSYCHOTHERAPY CENTER
Entity Type:Organization
Organization Name:INTERPERSONAL PSYCHOTHERAPY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:RILEY
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, CNS
Authorized Official - Phone:507-273-2316
Mailing Address - Street 1:300 3RD AVE SE STE 206
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55904-4632
Mailing Address - Country:US
Mailing Address - Phone:507-273-2316
Mailing Address - Fax:
Practice Address - Street 1:300 3RD AVE SE STE 206
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55904-4632
Practice Address - Country:US
Practice Address - Phone:507-273-2316
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-19
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, AdultGroup - Single Specialty