Healthcare Provider Details

I. General information

NPI: 1275624223
Provider Name (Legal Business Name): STEPHEN JAMES HEGARTY LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 4TH ST E STE 200
SAINT PAUL MN
55101-1697
US

IV. Provider business mailing address

275 4TH ST E STE 200
SAINT PAUL MN
55101-1697
US

V. Phone/Fax

Practice location:
  • Phone: 651-256-1224
  • Fax:
Mailing address:
  • Phone: 651-256-1224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number13356
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: