MEDICARE: MCNERNEY PSYCHOTHERAPY INC

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	546	MN
2	363LA2200X	Adult Health Nurse Practitioner	13122101

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	111620	OTHER	MN	UCARE

General Provider Information

NPI Number	:	1932223641
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MCNERNEY PSYCHOTHERAPY INC

Provider Business Mailing Address
First Line	:	3585 LEXINGTON AVE N
Second Line	:	#246
City	:	ST PAUL
State	:	MN
Zip	:	55126-8055
Country	:	US
Telephone Number	:	651-482-0164
Fax Number	:

Provider Business Practice Location Address
First Line	:	3585 LEXINGTON AVE N
Second Line	:	#246
City	:	ST PAUL
State	:	MN
Zip	:	55126-8055
Country	:	US
Telephone Number	:	651-482-0164
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. FLORENCE K MCNERNEY
Credential	:	RN CNS LICSW
Telephone Number	:	651-482-0164

Provider Enumeration Date	:	03/19/2007
Last Update Date	:	09/11/2025

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Directions to “MCNERNEY PSYCHOTHERAPY INC ” Practice Location

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