Individual
BERENDINA MARLEEN NUMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D. LP
Contact information
Practice address
430 OAK GROVE ST, SUITE 230, MINNEAPOLIS, MN 55403-3253
(612) 333-1766
(952) 475-1324
Mailing address
430 OAK GROVE ST, SUITE 230, MINNEAPOLIS, MN 55403-3253
(612) 333-1766
(952) 475-1324
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
LP 0955
MN
103TE1100X
Exercise & Sports Psychologist
LP 0955
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
27-132-300-081
CHAMPUS
MN
01
—
4114-7978
FEDERAL ID #-CCSM
MN
05
—
865547200
—
MN
Enumeration date
01/30/2007
Last updated
02/23/2010
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