Organization
SALLY R BRINZA PHD LP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SALLY ROSE BRINZA PHD (PSYCHOLOGIST)
(612) 978-5058
Entity
Organization
Contact information
Practice address
7225 FORESTVIEW LN N, MAPLE GROVE, MN 55369-5501
(612) 978-5058
Mailing address
7225 FORESTVIEW LN N, MAPLE GROVE, MN 55369-5501
(612) 978-5058
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
LP2586
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6420206
MINNESOTA CARE
MN
01
—
7140533-00
MINNESOTA HEALTH CARE PROGRAM MA
MN
Enumeration date
03/24/2011
Last updated
03/24/2011
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