Provider Demographics
NPI:1144810110
Name:THERAPY FOR REAL LIFE, A LICENSED CLINICAL SOCIAL WORKER PROF CORPS
Entity type:Organization
Organization Name:THERAPY FOR REAL LIFE, A LICENSED CLINICAL SOCIAL WORKER PROF CORPS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:LINDBERG CEDAR
Authorized Official - Suffix:
Authorized Official - Credentials:MPA, LCSW, LICSW
Authorized Official - Phone:510-606-5356
Mailing Address - Street 1:3209 GALLERIA UNIT 908
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2548
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3209 GALLERIA UNIT 908
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2548
Practice Address - Country:US
Practice Address - Phone:510-606-5356
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-22
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty