Center for Integrated Well Being Inc

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

CENTER FOR INTEGRATED WELL BEING INC

Practice address

1449 Grand Ave
Saint Paul, MN 55105-2206

Phone

(651) 698-0768

Fax

(651) 698-0660

NPI assigned

Nov 20, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Jeffry David Jeanetta Wark, MA LICSWNPI 1982778932

Title

Owner

Phone

(651) 698-0768

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jeffry David Jeanetta Wark, MA LICSW

  • Clinical Social Worker
  • Roseville, MN
  • NPI 1982778932
  Medicare reassignment Authorized official
• Bruce Eisenmenger, M.A., LP

  • Psychologist
  • Roseville, MN
  • NPI 1457370256
  NPD (past)
• Pamela Johnson, MA, LMFT, LP

  • Marriage & Family Therapist
  • Roseville, MN
  • NPI 1235158940
  NPD (past)

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

{
    "created_epoch": "1163980800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1053485003",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1449 GRAND AVE",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551052206",
            "telephone_number": "651-698-0768",
            "fax_number": "651-698-0660"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1449 GRAND AVE",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551052206",
            "telephone_number": "651-698-0768",
            "fax_number": "651-698-0660"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTER FOR INTEGRATED WELL BEING INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-20",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "JEANETTA WARK",
        "authorized_official_first_name": "JEFFRY",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "651-698-0768",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MA LICSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "13GS2WA",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VALUE OPTIONS",
            "identifier": "483889",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in Saint Paul, MN
• Providers in Saint Paul, MN by specialty
• Clinical Social Worker in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.