Provider Demographics
NPI:1285720813
Name:BEARMAN, DIANE L (PHD)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:L
Last Name:BEARMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UNIVERSITY OF MINNESOTA PHYSICIANS
Mailing Address - Street 2:420 DELAWARE ST SE MMC 741
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455
Mailing Address - Country:US
Mailing Address - Phone:612-884-0999
Mailing Address - Fax:
Practice Address - Street 1:PWB 3RD FLOOR, CLINIC 3A
Practice Address - Street 2:516 DELAWARE ST SE
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455
Practice Address - Country:US
Practice Address - Phone:612-884-0999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP4047103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNHP29851OtherHP
MN049219100Medicaid
MN900347OtherARAZ GROUP
MN1022957OtherPREFERREDONE
MN124387OtherUCARE
MN680011231OtherRAILROAD MEDICARE
MN174946OtherFAIRVIEW
MN61-63749OtherMEDICA-CHOICE
MN25G73BEOtherBLUE CROSS BLUE SHIELD
MN61-63749OtherMEDICA-CHOICE
MN680001171Medicare ID - Type Unspecified