Provider Demographics
NPI:1104626167
Name:PETERFESO, MAIJA (MSW LICSW)
Entity type:Individual
Prefix:
First Name:MAIJA
Middle Name:
Last Name:PETERFESO
Suffix:
Gender:
Credentials:MSW LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7101 YORK AVE S STE 317
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-4469
Mailing Address - Country:US
Mailing Address - Phone:763-703-4215
Mailing Address - Fax:877-775-3306
Practice Address - Street 1:1197 GRAND AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55105-2634
Practice Address - Country:US
Practice Address - Phone:763-703-4215
Practice Address - Fax:877-775-3306
Is Sole Proprietor?:No
Enumeration Date:2025-03-18
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN150501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical