Provider Demographics
NPI:1215139746
Name:DWYER, MARY ANN S MARGRETTA (LP LMFT)
Entity type:Individual
Prefix:
First Name:MARY ANN
Middle Name:S MARGRETTA
Last Name:DWYER
Suffix:
Gender:F
Credentials:LP LMFT
Other - Prefix:
Other - First Name:S MARGRETTA
Other - Middle Name:
Other - Last Name:DWYER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LP LMFT
Mailing Address - Street 1:5115 EXCELSIOR BLVD
Mailing Address - Street 2:449
Mailing Address - City:MPLS
Mailing Address - State:MN
Mailing Address - Zip Code:55416
Mailing Address - Country:US
Mailing Address - Phone:612-920-5351
Mailing Address - Fax:612-920-4485
Practice Address - Street 1:5115 EXCELSIOR BLVD
Practice Address - Street 2:449
Practice Address - City:MPLS
Practice Address - State:MN
Practice Address - Zip Code:55416
Practice Address - Country:US
Practice Address - Phone:612-920-5351
Practice Address - Fax:612-920-4485
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1229103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist