Healthcare Provider Details

I. General information

NPI: 1689478745
Provider Name (Legal Business Name): MELISSA OTILIA MCCARTY PSYD, LP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELISSA OTILIA WOLFGRAM

II. Dates (important events)

Enumeration Date: 04/01/2025
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 OSBORNE RD NE STE 210
FRIDLEY MN
55432-2872
US

IV. Provider business mailing address

2925 CHICAGO AVE
MINNEAPOLIS MN
55407-1321
US

V. Phone/Fax

Practice location:
  • Phone: 763-236-3800
  • Fax: 763-236-3821
Mailing address:
  • Phone: 612-262-9000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberLP7089
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberLP7089
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: