Individual
MAIMA FANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
7550 FRANCE AVE S STE 220, EDINA, MN 55435-4762
(612) 888-0313
Mailing address
7550 FRANCE AVE S STE 220, EDINA, MN 55435-4762
(612) 888-0313
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
22848
MN
1041C0700X
Clinical Social Worker
—
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
464974224
FEDERAL
MN
Enumeration date
05/10/2011
Last updated
06/11/2019
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