Ellen Therese Gormican, LICSW
Individual provider Active NPI Clinical Psychologist · Minneapolis, MN
NPI 1093698490 · NPPES record last updated Jul 31, 2025
Key facts
- NPI
- 1093698490
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Psychologist 103TC0700X
- License
- 30671 (MN)
- Practice address
- 3236 Longfellow Ave
Minneapolis, MN 55407-3805 - Phone
- (612) 807-6872
- NPI assigned
- Jul 31, 2025
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare Care Compare profile
- 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
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20260527000766 | MN | Practitioner - Clinical Social Worker | 4789154147 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 30671 | MN | MD | Clinical Psychologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 30671 | MN | Yes |
Addresses
Primary practice location
3236 Longfellow Ave
Minneapolis, MN 55407-3805
Mailing address
3236 Longfellow Ave
Minneapolis, MN 55407-3805
Phone (612) 807-6872
Other providers in Minneapolis, MN
- Janelle Lorraine Gorg Johnson
- Erin Gorham
- Sophia Gorham
- Sarah J Goring I
- Michele Ann Gorman
- Caroline Gormley
- Charles C Gornick
- Ayala Gorodzinsky
- Sarah M Gorr
- Egal Ismail Gorse
All providers in Minneapolis, MN · Clinical Psychologist in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 31, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.