Active NPI
Mary Beth Lardizabal, DO
- Psychiatry Physician
- Saint Paul, MN
National Provider Identifier
1366492076
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 39116
- Practice address
- 280 Smith Ave N Ste 450
Saint Paul, MN 55102-2481 - Phone
- (651) 241-5959
- NPI assigned
- May 11, 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 39116 | MN | Primary |
Addresses
Primary practice location
280 Smith Ave N Ste 450
Saint Paul, MN 55102-2481
Mailing address
2925 Chicago Ave
Minneapolis, MN 55407-1321
Phone (612) 262-4813
Other practice location 1
360 Sherman St
Saint Paul, MN 55102-2564
Phone (651) 241-5080
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | mlardizabal86042@excellian.direct.allina.com | Direct |
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
- Credentials
- Doctor of Osteopathy, Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 39116 | MN | MD | Psychiatry Physician |
Interoperability endpoints
- mlardizabal86042@excellian.direct.allina.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147305600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1615420800000",
"number": "1366492076",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2925 CHICAGO AVE",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554071321",
"telephone_number": "612-262-4813",
"fax_number": "612-262-4194"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "280 SMITH AVE N STE 450",
"city": "SAINT PAUL",
"state": "MN",
"postal_code": "551022481",
"telephone_number": "651-241-5959"
}
],
"practiceLocations": [
{
"address_1": "360 Sherman St",
"address_purpose": "LOCATION",
"city": "Saint Paul",
"state": "MN",
"postal_code": "551022564",
"country_code": "US",
"telephone_number": "651-241-5080",
"fax_number": "651-241-5958",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "LARDIZABAL",
"first_name": "MARY",
"middle_name": "BETH",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-05-11",
"last_updated": "2021-03-11",
"certification_date": "2021-03-11",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "MN",
"license": "39116",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "mlardizabal86042@excellian.direct.allina.com",
"affiliation": "N",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "CDA/PDF/TXT",
"address_1": "280 Smith Ave N Ste 450",
"city": "Saint Paul",
"state": "MN",
"country_code": "US",
"postal_code": "551022481",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Saint Paul, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.