Active NPI
Cimena Gordon, LICSW
- Clinical Social Worker
- Roseville, MN
National Provider Identifier
1104206630
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 16486
- Practice address
- 2277 Highway 36 W
Suite 310
Roseville, MN 55113-3804 - Phone
- (651) 224-2172
- NPI assigned
- May 29, 2015
- Last updated
- May 29, 2015
- 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 Social Worker | 1041C0700X | 16486 | MN | Primary |
Addresses
Primary practice location
2277 Highway 36 W
Suite 310
Roseville, MN 55113-3804
Mailing address
PO Box 7903
Saint Paul, MN 55107-0903
Phone (651) 224-2172
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Nov 1, 2021 through Nov 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 16486 | MN | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1432857600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1432857600000",
"number": "1104206630",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 7903",
"city": "SAINT PAUL",
"state": "MN",
"postal_code": "551070903",
"telephone_number": "651-224-2172"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2277 HIGHWAY 36 W",
"address_2": "SUITE 310",
"city": "ROSEVILLE",
"state": "MN",
"postal_code": "551133804",
"telephone_number": "651-224-2172"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GORDON",
"first_name": "CIMENA",
"credential": "LICSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-05-29",
"last_updated": "2015-05-29",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MN",
"license": "16486",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Roseville, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.