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NPI Code Detail

MEDICARE: DR. RICHARD EDWIN CLOSE DMIN, MA,LICSW, LMFT

MEDICARE: DR. RICHARD EDWIN CLOSE DMIN, MA,LICSW, LMFT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family Therapist0067MN
21041C0700XClinical Social Worker07734MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1457379026
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RICHARD EDWIN CLOSE DMIN, MA,LICSW, LMFT
Provider Business Mailing Address
First Line : 3450 OLEARY LN
Second Line :
City : EAGAN
State : MN
Zip : 55123-2340
Country : US
Telephone Number : 651-454-0114
Fax Number : 651-454-3492
Provider Business Practice Location Address
First Line : 3450 OLEARY LN
Second Line :
City : EAGAN
State : MN
Zip : 55123-2340
Country : US
Telephone Number : 651-454-0114
Fax Number : 651-454-3492
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/18/2006
Last Update Date : 12/15/2018

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