Provider Demographics
NPI:1063115095
Name:DENIO, ELIZABETH (MA)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:DENIO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6801 BLAISDELL AVE
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55423-2328
Mailing Address - Country:US
Mailing Address - Phone:612-545-8158
Mailing Address - Fax:
Practice Address - Street 1:4208 PARK GLEN RD
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55416-4758
Practice Address - Country:US
Practice Address - Phone:612-545-8158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health