| Doctor Name: | STEPHANIE LARSON BURCUSA |
| NPI Number: | 1235322421 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PHD |
| License Number: | 4950 |
| Business Practice Address: | 1660 Highway 100 S Suite 250 Saint Louis Park, MN - 554161529 |
| Business Phone Number: | 6516455323 |
| Business Fax Number: | |
| Mailing Address: | 1660 Highway 100 S, Suite 250 SAINT LOUIS PARK |
| State: | MN |
| Postal Code: | 554161529 |
| Phone Number: | 6516455323 |
| Fax Number: | |
| NPI Enumeration Date: | 08/22/2007 |
| NPI Last Update Date: | 09/18/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 4950 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |