MEDICARE: DR. MATANA LEVIA MORIN PHD

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
1	103TC0700X	Clinical Psychologist	LP3378	MN

General Provider Information

NPI Number	:	1275831984
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATANA LEVIA MORIN PHD

Provider Business Mailing Address
First Line	:	PO BOX 141139
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55414-6139
Country	:	US
Telephone Number	:	651-334-9561
Fax Number	:

Provider Business Practice Location Address
First Line	:	7525 4TH AVE
Second Line	:	SOTP
City	:	LINO LAKES
State	:	MN
Zip	:	55014-1006
Country	:	US
Telephone Number	:	651-717-6642
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/03/2011
Last Update Date	:	03/03/2011

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