Active NPI
Ellen Therese Gormican, LICSW
- Clinical Psychologist
- Minneapolis, MN
National Provider Identifier
1093698490
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 30671
- Practice address
- 3236 Longfellow Ave
Minneapolis, MN 55407-3805 - Phone
- (612) 807-6872
- NPI assigned
- Jul 31, 2025
- Last updated
- Jul 31, 2025
- Sex
- Female
- 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 Psychologist | 103TC0700X | 30671 | MN | Primary |
Addresses
Primary practice location
3236 Longfellow Ave
Minneapolis, MN 55407-3805
Mailing address
3236 Longfellow Ave
Minneapolis, MN 55407-3805
Phone (612) 807-6872
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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Social Worker
- Education
- Other, 2021
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
66 E Flagler St
Miami, FL 33130-1807
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 30671 | MN | MD | Clinical Psychologist |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1753920000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1753920000000",
"number": "1093698490",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3236 LONGFELLOW AVE",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554073805",
"telephone_number": "612-807-6872"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3236 LONGFELLOW AVE",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554073805",
"telephone_number": "612-807-6872"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GORMICAN",
"first_name": "ELLEN",
"middle_name": "THERESE",
"credential": "LICSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2025-07-31",
"last_updated": "2025-07-31",
"certification_date": "2025-07-31",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MN",
"license": "30671",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Minneapolis, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2025; 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.