MEDICARE: MISS ANASTASIA LOUISE CYPTAR 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
1	1041C0700X	Clinical Social Worker	12190	MN

General Provider Information

NPI Number	:	1376663963
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS ANASTASIA LOUISE CYPTAR LICSW

Provider Business Mailing Address
First Line	:	13220 GRAND OAK CT
Second Line	:
City	:	APPLE VALLEY
State	:	MN
Zip	:	55124-8756
Country	:	US
Telephone Number	:	952-953-3524
Fax Number	:

Provider Business Practice Location Address
First Line	:	317 YORK AVE
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55101-4039
Country	:	US
Telephone Number	:	651-774-0011
Fax Number	:	651-774-0606

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

Provider Enumeration Date	:	03/29/2007
Last Update Date	:	07/08/2007

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