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General NPI Number Information
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NPI Number | 1205920352
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Entity Type | Individual
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Provider Name | DIANA BERAN MS, LP
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Gender | Female
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 02/13/2012
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Provider Practice Location Address
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Address Line | 2450 RIVERSIDE AVE
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City | MINNEAPOLIS
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State | MN
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Zip | 55454-1450
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Country | US
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Telephone | 612-672-6999
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Fax | 612-672-2691
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Provider Business Mailing Address
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Address Line | 506 WILLOWMERE DR
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City | ZUMBROTA
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State | MN
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Zip | 55992-1297
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Country | US
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Telephone |
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | LP3979
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License Number State | MN
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