MEDICARE: MIDTOWN MANAGEMENT LTD

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	103T00000X	Psychologist	LP 2149	MN
2	103T00000X	Psychologist	LP 3528	MN

Other Identifiers

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

General Provider Information

NPI Number	:	1568585420
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIDTOWN MANAGEMENT LTD

Provider Business Mailing Address
First Line	:	2324 UNIVERSITY AVE W, STE 100
Second Line	:
City	:	ST PAUL
State	:	MN
Zip	:	55114-1854
Country	:	US
Telephone Number	:	651-641-1009
Fax Number	:	651-789-5677

Provider Business Practice Location Address
First Line	:	2324 UNIVERSITY AVE W, STE 100
Second Line	:
City	:	ST PAUL
State	:	MN
Zip	:	55114-1854
Country	:	US
Telephone Number	:	651-641-1009
Fax Number	:	651-789-5677

Authorized Official
Title or Position	:	THERAPIST/PARTNER
Name	:	JAMES WAGNER
Credential	:	LMFT
Telephone Number	:	651-641-1009

Provider Enumeration Date	:	04/07/2007
Last Update Date	:	03/24/2023

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Directions to “MIDTOWN MANAGEMENT LTD ” Practice Location

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