Individual
MARIE A DIAZ VARONA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSYD, LP
Contact information
Practice address
9555 UPLAND LN N, MAPLE GROVE, MN 55369-4485
(952) 993-1440
Mailing address
9555 UPLAND LN N, MAPLE GROVE, MN 55369-4485
(952) 993-1440
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
LP6508
MN
Other
Enumeration date
02/13/2020
Last updated
11/10/2020
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