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NPI Code Detail

MEDICARE: MRS. CHRISTINE C. KVIDERA MSW, LICSW

MEDICARE: MRS. CHRISTINE C. KVIDERA 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 Worker08679MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
28G623GROTHERMNBCBS OF MN

General Provider Information

NPI Number : 1568489649
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. CHRISTINE C. KVIDERA MSW, LICSW
Provider Business Mailing Address
First Line : 7362 UNIVERSITY AVE NE
Second Line : SUITE 101
City : FRIDLEY
State : MN
Zip : 55432-3142
Country : US
Telephone Number : 763-503-3981
Fax Number : 763-503-3981
Provider Business Practice Location Address
First Line : 7362 UNIVERSITY AVE NE
Second Line : SUITE 101
City : FRIDLEY
State : MN
Zip : 55432-3142
Country : US
Telephone Number : 763-503-3981
Fax Number : 763-503-3981
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/16/2006
Last Update Date : 05/13/2008

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