Jacob Nicholaus Maruska, LPCC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

3957 Issued in MN

Practice address

5637 Brooklyn Blvd
Brooklyn Center, MN 55429-3061

Phone

(612) 232-1073

Fax

(763) 951-2132

NPI assigned

Apr 6, 2023

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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.

• Helena Autism Therapy Center, Inc

  • Community/Behavioral Health Agency
  • Fridley, MN
  • NPI 1922449057
  NPD
• Helena Family Support Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Brooklyn Center, MN
  • NPI 1831921162
  NPD

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

{
    "created_epoch": "1680739200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1680739200000",
    "number": "1124713037",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5637 BROOKLYN BLVD",
            "city": "BROOKLYN CENTER",
            "state": "MN",
            "postal_code": "554293061",
            "telephone_number": "612-232-1073"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5637 BROOKLYN BLVD",
            "city": "BROOKLYN CENTER",
            "state": "MN",
            "postal_code": "554293061",
            "telephone_number": "612-232-1073",
            "fax_number": "763-951-2132"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARUSKA",
        "first_name": "JACOB",
        "middle_name": "NICHOLAUS",
        "credential": "LPCC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-04-06",
        "last_updated": "2023-04-06",
        "certification_date": "2023-04-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MN",
            "license": "3957",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Todd William Marshall, DDS
• Phillip Blair Martelly I
• Thomas Martens
• Robert R. Martin, D.C
• Elva Martinez, LADC
• Jeanne Masanz, DC
• Mason Health Center
• Keith Brian Mastin, MD
• Diane Mathisen, MSW,LICSW
• Shanika Matthews

• Professional Counselor in Brooklyn Center, MN
• Providers in Brooklyn Center, MN by specialty
• Professional Counselor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.