Provider Demographics
NPI:1386716983
Name:MAPLEWOOD PSYCHOLOGY P.A.
Entity type:Organization
Organization Name:MAPLEWOOD PSYCHOLOGY P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:M
Authorized Official - Last Name:WICK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LP
Authorized Official - Phone:651-770-1311
Mailing Address - Street 1:2399 ARIEL ST N STE D
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55109-2203
Mailing Address - Country:US
Mailing Address - Phone:651-770-1311
Mailing Address - Fax:651-770-1879
Practice Address - Street 1:2399 ARIEL ST N STE D
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-2203
Practice Address - Country:US
Practice Address - Phone:651-770-1311
Practice Address - Fax:651-770-1879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty