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NPI Code Detail

MEDICARE: MAIJA PETERFESO MSW LICSW

MEDICARE: MAIJA PETERFESO MSW LICSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker15050MN

General Provider Information

NPI Number : 1104626167
Entity Type Code : Individual
Provider Name (Legal Business Name) : MAIJA PETERFESO MSW LICSW
Provider Business Mailing Address
First Line : 7101 YORK AVE S STE 317
Second Line :
City : EDINA
State : MN
Zip : 55435-4469
Country : US
Telephone Number : 763-703-4215
Fax Number : 877-775-3306
Provider Business Practice Location Address
First Line : 1197 GRAND AVE
Second Line :
City : SAINT PAUL
State : MN
Zip : 55105-2634
Country : US
Telephone Number : 763-703-4215
Fax Number : 877-775-3306
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/18/2025
Last Update Date : 03/18/2025

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