Active NPI
Theodore Raymond Page, LICSW
- Clinical Social Worker
- Saint Paul, MN
National Provider Identifier
1083772313
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 15079
- Practice address
- 491 Ohio St
Saint Paul, MN 55107-2656 - Phone
- (651) 278-1771
- NPI assigned
- Dec 6, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 15079 | MN | Primary |
Addresses
Primary practice location
491 Ohio St
Saint Paul, MN 55107-2656
Mailing address
491 Ohio St
Saint Paul, MN 55107-2656
Phone (651) 278-1771
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)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165363200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1202688000000",
"number": "1083772313",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "491 OHIO ST",
"city": "SAINT PAUL",
"state": "MN",
"postal_code": "551072656",
"telephone_number": "651-278-1771"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "491 OHIO ST",
"city": "SAINT PAUL",
"state": "MN",
"postal_code": "551072656",
"telephone_number": "651-278-1771"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PAGE",
"first_name": "THEODORE",
"middle_name": "RAYMOND",
"credential": "LICSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-12-06",
"last_updated": "2008-02-11",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MN",
"license": "15079",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Paul, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.