Provider Demographics
NPI:1982825212
Name:AVINA, ROBERTO R (LICSW, LMFT)
Entity Type:Individual
Prefix:
First Name:ROBERTO
Middle Name:R
Last Name:AVINA
Suffix:
Gender:M
Credentials:LICSW, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 WABASHA ST S
Mailing Address - Street 2:SUITE 120
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55107-1801
Mailing Address - Country:US
Mailing Address - Phone:651-221-0913
Mailing Address - Fax:651-221-0785
Practice Address - Street 1:155 WABASHA ST S
Practice Address - Street 2:SUITE 120
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55107-1801
Practice Address - Country:US
Practice Address - Phone:651-221-0913
Practice Address - Fax:651-221-0785
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN23891041C0700X
MN400106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN62-05810OtherUBH
MN1023405OtherPREFFERED ONE
MN39Q84AVOtherBCBS
MNHP23622OtherHEALTH PARTNERS
MN120502OtherU CARE