Healthcare Provider Details

I. General information

NPI: 1275667511
Provider Name (Legal Business Name): BIRBILIS AND ASSOCIATES, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2721 UPPER AFTON RD E STE 101
MAPLEWOOD MN
55119-4760
US

IV. Provider business mailing address

2721 UPPER AFTON RD E STE 101
MAPLEWOOD MN
55119-4760
US

V. Phone/Fax

Practice location:
  • Phone: 651-739-6167
  • Fax:
Mailing address:
  • Phone: 651-739-6167
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name: DR. JEAN M BIRBILIS
Title or Position: PRESIDENT
Credential: PH.D., L.P.
Phone: 651-739-6167