Healthcare Provider Details

I. General information

NPI: 1841522901
Provider Name (Legal Business Name): MONIZA PSYCHOLOGICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2010
Last Update Date: 01/31/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11900 WAYZATA BLVD SUITE 132
MINNETONKA MN
55305-2031
US

IV. Provider business mailing address

13389 GRANADA AVE
APPLE VALLEY MN
55124-7619
US

V. Phone/Fax

Practice location:
  • Phone: 952-236-6188
  • Fax:
Mailing address:
  • Phone: 612-964-7946
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberLP4570
License Number StateMN

VIII. Authorized Official

Name: DR. CAROLINE R. MONIZA
Title or Position: PSYCHOLOGIST
Credential: LP
Phone: 612-964-7946