MEDICARE: CARISE MARIE ROTACH-BEARD MA, LAMFT

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	106H00000X	Marriage & Family Therapist	2445	MN

General Provider Information

NPI Number	:	1992052633
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARISE MARIE ROTACH-BEARD MA, LAMFT

Provider Business Mailing Address
First Line	:	100 W FRANKLIN AVE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55404-2433
Country	:	US
Telephone Number	:	651-983-9215
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 W FRANKLIN AVE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55404-2433
Country	:	US
Telephone Number	:	651-983-9215
Fax Number	:

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

Provider Enumeration Date	:	08/13/2012
Last Update Date	:	08/13/2012

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