Active NPI
Samantha Tidd, MSW, LICSW
- Clinical Social Worker
- Brooklyn Park, MN
National Provider Identifier
1144977786
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 24053
- Practice address
- 5500 94TH Ave N
Brooklyn Park, MN 55443-1992 - Phone
- (763) 226-1647
- NPI assigned
- Mar 3, 2022
- Sex
- Female
- Sole proprietor
- No
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 | 24053 | MN | Primary |
Addresses
Primary practice location
5500 94TH Ave N
Brooklyn Park, MN 55443-1992
Mailing address
5500 94TH Ave N
Brooklyn Park, MN 55443-1992
Phone (763) 226-1647
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 24053 | MN | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Prairiecare LLC | Clinical | Past | Accepting new patients |
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 and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1646265600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1646265600000",
"number": "1144977786",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5500 94TH AVE N",
"city": "BROOKLYN PARK",
"state": "MN",
"postal_code": "554431992",
"telephone_number": "763-226-1647"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5500 94TH AVE N",
"city": "BROOKLYN PARK",
"state": "MN",
"postal_code": "554431992",
"telephone_number": "763-226-1647"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TIDD",
"first_name": "SAMANTHA",
"credential": "MSW, LICSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-03-03",
"last_updated": "2022-03-03",
"certification_date": "2022-03-03",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MN",
"license": "24053",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brooklyn Park, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.