Active NPI
Dorothy Sue Edelson, PSY.D., L.P.
- Clinical Psychologist
- Brooklyn Center, MN
National Provider Identifier
1356412498
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- LP3108
- Practice address
- 6120 Earle Brown Dr
Ste. 520
Brooklyn Center, MN 55430-2123 - Phone
- (763) 531-0566
- Fax
- (763) 531-0602
- NPI assigned
- Nov 12, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | LP3108 | MN | |
| Clinical Psychologist | 103TC0700X | LP3108 | MN | Primary |
Addresses
Primary practice location
6120 Earle Brown Dr
Ste. 520
Brooklyn Center, MN 55430-2123
Mailing address
6120 Earle Brown Dr
Ste. 520
Brooklyn Center, MN 55430-2123
Phone (763) 531-0566
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 385823500 | Medicaid | MN | |
| 66B68ED | Other | MN | BLUECROSSBLUESHIELD |
| 61-40441 | Other | MN | MEDICA |
| 97351777 | Medicaid | MN |
Other names 1
- Dr. Dorothy E Japuntich
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163289600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1479340800000",
"number": "1356412498",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6120 EARLE BROWN DR",
"address_2": "STE. 520",
"city": "BROOKLYN CENTER",
"state": "MN",
"postal_code": "554302123",
"telephone_number": "763-531-0566",
"fax_number": "763-531-0602"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6120 EARLE BROWN DR",
"address_2": "STE. 520",
"city": "BROOKLYN CENTER",
"state": "MN",
"postal_code": "554302123",
"telephone_number": "763-531-0566",
"fax_number": "763-531-0602"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EDELSON",
"first_name": "DOROTHY",
"middle_name": "SUE",
"name_prefix": "Dr.",
"credential": "PSY.D., L.P.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-11-12",
"last_updated": "2016-11-17",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "MN",
"license": "LP3108",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MN",
"license": "LP3108",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "385823500",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUECROSSBLUESHIELD",
"identifier": "66B68ED",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICA",
"identifier": "61-40441",
"state": "MN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "97351777",
"state": "MN"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "DOROTHY",
"last_name": "JAPUNTICH",
"middle_name": "E",
"prefix": "DR.",
"credential": "PSY.D., LP",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Brooklyn Center, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.