Individual provider Active NPI

Sneha Madhwa Raj, PSY.D

  • Psychologist
  • Maple Grove, MN
National Provider Identifier
1245754019
Registry record updated Jan 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
LP6214 Issued in MN
Practice address
11670 Fountains Dr Ste 200
Maple Grove, MN 55369-7195
Phone
(612) 314-5602
NPI assigned
Aug 2, 2017
Last updated
Jan 27, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 27, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X LP6214 MN Primary
Clinical Psychologist 103TC0700X 20043025 IN

Addresses

Primary practice location

11670 Fountains Dr Ste 200
Maple Grove, MN 55369-7195

Mailing address

11670 Fountains Dr Ste 200
Maple Grove, MN 55369-7195
Phone (612) 314-5602

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
85.6 of 100Reported as group
Quality
72.5
Promoting interoperability
100
Improvement activities
40
Cost
77.07

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
LP6214MNMDPsychologist
20043025INMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Sneha M Raj Vikas Psychology Clinical Current Accepting new patients
Allina Health System Current Accepting new patients
Allina Health System CurrentSince Dec 31, 2022 Accepting new patients
Allina Health System CurrentSince Oct 18, 2017 Accepting new patients
Allina Health System CurrentSince Oct 18, 2017 Accepting new patients

Locations

440 Elm St E
Annandale, MN 55302
Phone (320) 682-5225

11670 Fountains Dr N
Ste 200
Maple Grove, MN 55369
Phone (612) 355-0693

2215 Park Ave
Minneapolis, MN 55404
Phone (612) 775-8800

2925 Chicago Ave
#10957
Minneapolis, MN 55407
Phone (612) 262-8640

7231 Sunwood Dr NW
Ramsey, MN 55303
Phone (763) 236-0000

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1501632000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737936000000",
    "number": "1245754019",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11670 FOUNTAINS DR STE 200",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553697195",
            "telephone_number": "612-314-5602"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11670 FOUNTAINS DR STE 200",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553697195",
            "telephone_number": "612-314-5602"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAJ",
        "first_name": "SNEHA",
        "middle_name": "MADHWA",
        "name_prefix": "Dr.",
        "credential": "PSY.D",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-08-02",
        "last_updated": "2025-01-27",
        "certification_date": "2025-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MN",
            "license": "LP6214",
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IN",
            "license": "20043025",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Maple Grove, MN

Sources for this page

Verify at the official NPI Registry.