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General NPI Number Information
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NPI Number | 1588793723
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Entity Type | Organization
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Legal Business Name | YASMINE MOIDEEN, PHD, LP, LLC
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Dates
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Enumeration Date | 03/05/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2332 LEXINGTON AVE N
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City | ROSEVILLE
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State | MN
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Zip | 55113-4336
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Country | US
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Telephone | 651-484-0000
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Fax | 651-639-1314
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Provider Business Mailing Address
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Address Line | 2332 LEXINGTON AVE N
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City | ROSEVILLE
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State | MN
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Zip | 55113-4336
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Country | US
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Telephone | 651-484-0000
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Fax | 651-639-1314
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. YASMINE MOIDEEN
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Credential | PHD, LP
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Telephone | 651-484-0000
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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 | LP3742
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License Number State | MN
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