Provider Demographics
NPI:1316286974
Name:NORTH STAR MENTAL HEALTH, LLC
Entity type:Organization
Organization Name:NORTH STAR MENTAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:CARLO
Authorized Official - Middle Name:A
Authorized Official - Last Name:GIACOMONI
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:763-232-8901
Mailing Address - Street 1:2984 RICE ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE CANADA
Mailing Address - State:MN
Mailing Address - Zip Code:55113-2230
Mailing Address - Country:US
Mailing Address - Phone:651-314-4350
Mailing Address - Fax:
Practice Address - Street 1:2984 RICE ST
Practice Address - Street 2:
Practice Address - City:LITTLE CANADA
Practice Address - State:MN
Practice Address - Zip Code:55113-2230
Practice Address - Country:US
Practice Address - Phone:651-314-4350
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-01
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5506103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty