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General NPI Number Information
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NPI Number | 1003453473
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Entity Type | Individual
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Provider Name | ELIZABETH SUBRAMANIAM MA
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Gender | Female
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Dates
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Enumeration Date | 12/04/2019
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Last Update Date | 12/04/2019
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Provider Practice Location Address
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Address Line | 658 GRAND AVE
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City | SAINT PAUL
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State | MN
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Zip | 55105-3417
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Country | US
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Telephone | 612-920-2030
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Fax |
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Provider Business Mailing Address
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Address Line | 9025 W 31ST ST
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City | ST LOUIS PARK
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State | MN
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Zip | 55426-2969
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Country | US
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Telephone | 612-387-6596
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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