Center for Mindful Dialogue, PA

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

LP1749 Issued in MN

Legal business name

CENTER FOR MINDFUL DIALOGUE, PA

Practice address

416 E Hennepin Ave
Suite 107
Minneapolis, MN 55414-1006

Phone

(612) 379-5360

Fax

(612) 379-5353

NPI assigned

May 3, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Martha Susan Cohen, PH.D.

Title

President

Phone

(612) 379-5360

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1178150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1104038215",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "416 E HENNEPIN AVE",
            "address_2": "SUITE 107",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554141006",
            "telephone_number": "612-379-5360",
            "fax_number": "612-379-5353"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "416 E HENNEPIN AVE",
            "address_2": "SUITE 107",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554141006",
            "telephone_number": "612-379-5360",
            "fax_number": "612-379-5353"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTER FOR MINDFUL DIALOGUE, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-03",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "COHEN",
        "authorized_official_first_name": "MARTHA",
        "authorized_official_middle_name": "SUSAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "612-379-5360",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "MN",
            "license": "LP1749",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSSBLUESHIELD",
            "identifier": "02849CO",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Clinical Psychologist in Minneapolis, MN
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.