Clarissa Detrie, MSW

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Practice address

300 Crooks St
Green Bay, WI 54301-4527

Phone

(920) 436-6800

Fax

(920) 437-3540

NPI assigned

Jan 5, 2009

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Clarissa Winney Former name

Medicare fee-for-service enrollment

Enrolled in WI

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, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

JB Behavioral Health, LLCGroup PAC ID 7113390972, 8 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• JB Behavioral Health, LLC

  • Adult Mental Health Clinic/Center
  • De Pere, WI
  • NPI 1164148847
  Medicare reassignment Care Compare group NPD
• Family Services of Northeast Wisconsin Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Menasha, WI
  • NPI 1275525925
  Medicare reassignment NPD
• Family Services of Northeast Wisconsin Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Green Bay, WI
  • NPI 1467453167
  NPD

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

{
    "created_epoch": "1231113600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1418601600000",
    "number": "1073759577",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 CROOKS ST",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543014527",
            "telephone_number": "920-436-6800",
            "fax_number": "920-437-3540"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 CROOKS ST",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543014527",
            "telephone_number": "920-436-6800",
            "fax_number": "920-437-3540"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DETRIE",
        "first_name": "CLARISSA",
        "credential": "MSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-01-05",
        "last_updated": "2014-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1073759577",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CLARISSA",
            "last_name": "WINNEY",
            "credential": "MSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Ashley Desanctis, BCBA
• Heidi L Destree, MA
• Katrina Lynn Destree, M.D.
• Nathan Reid Deterville, PT, DPT
• Karen A Detrick, COTA
• Melissa A Detrie, LPC, SAC-IT
• Sara Dettlaff, APNP
• Shanna E Devos, APSW, SW
• Amy Deweert, COTA
• Diane Lynn Dewinter, LPN

• Mental Health Counselor in Green Bay, WI
• Providers in Green Bay, WI by specialty
• Mental Health Counselor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2014; 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.