Mary Beth Thomas, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

12849 Issued in MN

Practice address

207 Avenue C
Suite 202
Cloquet, MN 55720-1584

Phone

(218) 655-3347

Fax

(218) 655-3390

NPI assigned

Apr 3, 2007

Last updated

Jan 23, 2009By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 2

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Interoperability endpoints

• FHIR API: https://api.qualifacts.org/api/fhir/humandevelopmentcenter/r4/

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.

• Emily Program P C

  dba The Emily Program

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Saint Paul, MN
  • NPI 1528165065
  Medicare reassignment
• Winds of Change Counseling Services Inc

  • Clinical Social Worker
  • Cloquet, MN
  • NPI 1104065192
  Authorized official Same address or phone
• Brightwater Health Dba Human Development Center

  • Community/Behavioral Health Agency
  • Cloquet, MN
  • NPI 1114048527
  NPD (past)
• Brightwater Health Dba Human Development Center

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Duluth, MN
  • NPI 1194790733
  NPD (past)

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

{
    "created_epoch": "1175558400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1232668800000",
    "number": "1184746133",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "207 AVENUE C",
            "address_2": "SUITE 202",
            "city": "CLOQUET",
            "state": "MN",
            "postal_code": "557201584",
            "telephone_number": "218-655-3347"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "207 AVENUE C",
            "address_2": "SUITE 202",
            "city": "CLOQUET",
            "state": "MN",
            "postal_code": "557201584",
            "telephone_number": "218-655-3347",
            "fax_number": "218-655-3390"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THOMAS",
        "first_name": "MARY",
        "middle_name": "BETH",
        "credential": "LICSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-04-03",
        "last_updated": "2009-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "12849",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CO",
            "license": "993074",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "800001494",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "766160600",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• April Terry, RN
• Amy Patricia Tester, PHARM D
• The Duluth Clinic LTD (Essentia Health Cloquet Clinic)
• The Duluth Clinic, LTD (Essentia Health Cloquet Pharmacy)
• The Duluth Clinic, LTD (Essentia Health-Cloquet Therapy)
• Amanda Irene Thompson
• Verna Alberta Thornton, MD
• Ashley Maxine Tollefson
• James J Tomhave, DDS
• Lucas Tomhave, DDS

• Clinical Social Worker in Cloquet, MN
• Providers in Cloquet, MN by specialty
• Clinical Social Worker in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2009; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.