Active NPI
Mary Lee Roske-Groth, LICSW, LADC
- Clinical Social Worker
- Minneapolis, MN
National Provider Identifier
1194897652
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 14998
- Practice address
- 410 Church St SE
Boynton Health Service
Minneapolis, MN 55455-0340 - Phone
- (612) 624-1444
- Fax
- (612) 625-7155
- NPI assigned
- Nov 13, 2006
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 300299 | MN | |
| Clinical Social Worker | 1041C0700X | 14998 | MN | Primary |
Addresses
Primary practice location
410 Church St SE
Boynton Health Service
Minneapolis, MN 55455-0340
Mailing address
410 Church St SE
Minneapolis, MN 55455-0340
Phone (612) 624-7172
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 300299 | MN | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163376000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1282694400000",
"number": "1194897652",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "410 CHURCH ST SE",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554550340",
"telephone_number": "612-624-7172",
"fax_number": "612-625-1434"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "410 CHURCH ST SE",
"address_2": "BOYNTON HEALTH SERVICE",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554550340",
"telephone_number": "612-624-1444",
"fax_number": "612-625-7155"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROSKE-GROTH",
"first_name": "MARY",
"middle_name": "LEE",
"credential": "LICSW, LADC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-11-13",
"last_updated": "2010-08-25",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "MN",
"license": "300299",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MN",
"license": "14998",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Minneapolis, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.