Elizabeth Mousseau Maldonado, LGSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

28879 Issued in MN

Practice address

2729 13TH Ave E
Hibbing, MN 55746-2314

Phone

(218) 293-4789

NPI assigned

Jan 15, 2021

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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

Specialty

Clinical Social Worker

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Radical Wellness LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Hibbing, MN
  • NPI 1770310799

  Clinical

  NPD Authorized official
• Lakeview Behavioral Health Inc.

  • Community/Behavioral Health Agency
  • Grand Rapids, MN
  • NPI 1154404325
  NPD (past)

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

{
    "created_epoch": "1610668800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610668800000",
    "number": "1053900712",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 CENTRAL AVE NE APT 202",
            "city": "CHISHOLM",
            "state": "MN",
            "postal_code": "557191847",
            "telephone_number": "218-996-2144"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2729 13TH AVE E",
            "city": "HIBBING",
            "state": "MN",
            "postal_code": "557462314",
            "telephone_number": "218-293-4789"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALDONADO",
        "first_name": "ELIZABETH",
        "middle_name": "MOUSSEAU",
        "credential": "LGSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-01-15",
        "last_updated": "2021-01-15",
        "certification_date": "2021-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "28879",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jessica Lynn Lundquist, LPCC
• Cheyenne Leigh Lustila
• Shannon Cathleen Lustila
• Sara Madden, PHARM.D.
• William A. Magajna, DDS
• Christy Joy Malone, LPC, LPCC
• Michael Joseph Maras, CRNA
• Jacqueline A Marchetti, RN
• Gail Diane Martin Bartlett, APRN
• Ashton Whitney Martin, RN

• Clinical Social Worker in Hibbing, MN
• Providers in Hibbing, 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 Jan 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.