Healthcare Provider Details

I. General information

NPI: 1639352974
Provider Name (Legal Business Name): MARIA A OTHMAN-WARREN MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2007
Last Update Date: 12/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 4TH AVE S SUITE 475N
MINNEAPOLIS MN
55415-1012
US

IV. Provider business mailing address

310 4TH AVE S SUITE 475N
MINNEAPOLIS MN
55415-1012
US

V. Phone/Fax

Practice location:
  • Phone: 612-348-8801
  • Fax: 612-317-6201
Mailing address:
  • Phone: 612-348-8801
  • Fax: 612-317-6201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number18192
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: