Provider Demographics
NPI:1144298365
Name:DUNNAVAN, MARY STEVENSON (MSW)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:STEVENSON
Last Name:DUNNAVAN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7200 FRANCE AVENUE SOUTH
Mailing Address - Street 2:SUITE 234
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435
Mailing Address - Country:US
Mailing Address - Phone:952-831-0601
Mailing Address - Fax:952-831-0614
Practice Address - Street 1:7200 FRANCE AVENUE SOUTH
Practice Address - Street 2:SUITE 234
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435
Practice Address - Country:US
Practice Address - Phone:952-831-0601
Practice Address - Fax:952-831-0614
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN17311041C0700X
MN584106H00000X
MN01731104100000X
MN0584106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN827757500Medicaid
MN800001884Medicare PIN