Provider Demographics
NPI:1538195862
Name:BLUVSHTEIN, MARINA (PHD LP)
Entity type:Individual
Prefix:
First Name:MARINA
Middle Name:
Last Name:BLUVSHTEIN
Suffix:
Gender:F
Credentials:PHD LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4900 HIGHWAY 169 N
Mailing Address - Street 2:SUITE 309
Mailing Address - City:NEW HOPE
Mailing Address - State:MN
Mailing Address - Zip Code:55428-4058
Mailing Address - Country:US
Mailing Address - Phone:763-231-0333
Mailing Address - Fax:
Practice Address - Street 1:4900 HIGHWAY 169 N
Practice Address - Street 2:SUITE 309
Practice Address - City:NEW HOPE
Practice Address - State:MN
Practice Address - Zip Code:55428-4058
Practice Address - Country:US
Practice Address - Phone:763-231-0333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-26
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN937106H00000X
MN4926103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN160003OtherUCARE MN
MN32389OtherHEALTH PARTNERS
MN7426976-00Medicaid
MN62-45489OtherUNITED BEHAVIORAL HEALTH
MN2085749OtherSIGNA BEHAVIORAL HEALTH
MN10312001OtherMETROPOLITAN HEALTH PLAN
MN98D67BL -- 98D68BLOtherBCBS MN