Active NPI
Marissa Mahanna, MINNESOTA LSW
- Social Worker
- Fargo, ND
National Provider Identifier
1023784543
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 19282
- Practice address
- 414 11TH St N
Fargo, ND 58102-4312 - Phone
- (701) 478-1097
- NPI assigned
- Aug 17, 2021
- Last updated
- Aug 17, 2021
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Social Worker | 104100000X | 19282 | MN | Primary |
Addresses
Primary practice location
414 11TH St N
Fargo, ND 58102-4312
Mailing address
600 S 2ND St # 308C
Bismarck, ND 58504-5726
Phone (701) 223-4517
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 19282 | MN | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1629158400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1629158400000",
"number": "1023784543",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "600 S 2ND ST # 308C",
"city": "BISMARCK",
"state": "ND",
"postal_code": "585045726",
"telephone_number": "701-223-4517"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "414 11TH ST N",
"city": "FARGO",
"state": "ND",
"postal_code": "581024312",
"telephone_number": "701-478-1097"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAHANNA",
"first_name": "MARISSA",
"credential": "MINNESOTA LSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-08-17",
"last_updated": "2021-08-17",
"certification_date": "2021-08-17",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "MN",
"license": "19282",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fargo, ND
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.