Provider Demographics
NPI:1285791202
Name:BARRETT, DIANE PATRICIA (PHD LP)
Entity type:Individual
Prefix:DR
First Name:DIANE
Middle Name:PATRICIA
Last Name:BARRETT
Suffix:
Gender:F
Credentials:PHD LP
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Mailing Address - Street 1:311 RAMSEY ST
Mailing Address - Street 2:RAMSEY PROFESSIONAL BUILDING
Mailing Address - City:ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102
Mailing Address - Country:US
Mailing Address - Phone:651-291-8070
Mailing Address - Fax:651-227-6559
Practice Address - Street 1:311 RAMSEY ST
Practice Address - Street 2:RAMSEY PROFESSIONAL BUILDING
Practice Address - City:ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102
Practice Address - Country:US
Practice Address - Phone:651-291-8070
Practice Address - Fax:651-227-6559
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MNLP1631MN103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN415848200OtherMEDICAL ASSISTANCE
MN4H795BAOtherBLUE CROSS BLUE SHIELD
111535OtherHEALTH PARTNERS