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General NPI Number Information
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NPI Number | 1588142145
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Entity Type | Individual
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Provider Name | MAREN MITTAL LICSW
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Gender | Female
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Dates
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Enumeration Date | 08/04/2018
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Last Update Date | 11/15/2024
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Provider Practice Location Address
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Address Line | 1675 VILLAGE TRL E UNIT 6
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City | MAPLEWOOD
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State | MN
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Zip | 55109-5820
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Country | US
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Telephone | 612-440-7771
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Fax |
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Provider Business Mailing Address
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Address Line | 1675 VILLAGE TRL E UNIT 6
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City | MAPLEWOOD
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State | MN
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Zip | 55109-5820
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Country | US
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Telephone | 612-440-7771
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 21529
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License Number State | MN
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