Individual provider Active NPI

Bravada Mae Garrett-Akinsanya, PHD, LP, LICSW

  • Clinical Psychologist
  • Minneapolis, MN
National Provider Identifier
1033294962
Registry record updated Jan 30, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
LP4105 Issued in MN
Practice address
1501 Xerxes Ave N
Minneapolis, MN 55411-2851
Phone
(763) 522-0100
NPI assigned
Oct 26, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 30, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X LP4105 MN Primary
Clinical Social Worker 1041C0700X 25104 MN

Addresses

Primary practice location

1501 Xerxes Ave N
Minneapolis, MN 55411-2851

Mailing address

1501 Xerxes Ave N
Minneapolis, MN 55411-2851
Phone (753) 522-0100

Other practice location 1

2100 Plymouth Ave N Ste 245
Minneapolis, MN 55411-3675
Phone (612) 302-3140

Other identifiers 4

IdentifierTypeStateIssuer
426S3GAOtherMNBLUE CROSS BLUE SHIELD
HP29938OtherMNHEALTHPARTNERS
6168492OtherMNUNITED BEHAVIORAL HEALTH
239323900MedicaidMN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070517000318 MN Practitioner - Clinical Psychologist 6103923685

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
25104MNMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
African American Child Wellness Institute Current Accepting new patients
J Taborn Associates Inc Past Accepting new patients

Locations

1501 Xerxes Ave N
Minneapolis, MN 55411
Phone (612) 728-2061

2100 Plymouth Ave N
Ste 245
Minneapolis, MN 55411
Phone (612) 302-3140

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161820800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1769731200000",
    "number": "1033294962",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1501 XERXES AVE N",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554112851",
            "telephone_number": "753-522-0100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501 XERXES AVE N",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554112851",
            "telephone_number": "763-522-0100"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2100 Plymouth Ave N Ste 245",
            "address_purpose": "LOCATION",
            "city": "Minneapolis",
            "state": "MN",
            "postal_code": "554113675",
            "country_code": "US",
            "telephone_number": "612-302-3140",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GARRETT-AKINSANYA",
        "first_name": "BRAVADA",
        "middle_name": "MAE",
        "name_prefix": "Dr.",
        "credential": "PHD, LP, LICSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-26",
        "last_updated": "2026-01-30",
        "certification_date": "2026-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MN",
            "license": "LP4105",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "25104",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "426S3GA",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHPARTNERS",
            "identifier": "HP29938",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED BEHAVIORAL HEALTH",
            "identifier": "6168492",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "239323900",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

Verify at the official NPI Registry.