Active NPI
Seth Gordon Disner, PHD, LP
- Clinical Psychologist
- Minneapolis, MN
National Provider Identifier
1831740216
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- LP6451
- Practice address
- 1 Veterans Dr # B68-2
Minneapolis, MN 55417-2309 - Phone
- (612) 629-7349
- NPI assigned
- Sep 26, 2019
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | LP6451 | MN | Primary |
Addresses
Primary practice location
1 Veterans Dr # B68-2
Minneapolis, MN 55417-2309
Mailing address
2506 Grand Ave S
Minneapolis, MN 55405-3436
Phone (310) 560-5990
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)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LP6451 | MN | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1569456000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1569456000000",
"number": "1831740216",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2506 GRAND AVE S",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554053436",
"telephone_number": "310-560-5990"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 VETERANS DR # B68-2",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554172309",
"telephone_number": "612-629-7349"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DISNER",
"first_name": "SETH",
"middle_name": "GORDON",
"name_prefix": "Dr.",
"credential": "PHD, LP",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-09-26",
"last_updated": "2019-09-26",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MN",
"license": "LP6451",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Minneapolis, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.