Healthcare Provider Details

I. General information

NPI: 1861815490
Provider Name (Legal Business Name): BRITTA MARIE LUNDBERG PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BRITTA MARIE TORGERSON, JABBAR

II. Dates (important events)

Enumeration Date: 02/03/2014
Last Update Date: 09/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 NORTHWOODS DR
ARDEN HILLS MN
55112-6966
US

IV. Provider business mailing address

4422 WHITE BEAR AVE N SUITE 100
WHITE BEAR LAKE MN
55110-3475
US

V. Phone/Fax

Practice location:
  • Phone: 651-787-9600
  • Fax:
Mailing address:
  • Phone: 763-400-7837
  • Fax: 763-400-7444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number3428-57
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberGL0057
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: