Active NPI
Susan Marie Gallucci, L.I.C.S.W.
- Clinical Social Worker
- St Louis Park, MN
National Provider Identifier
1235337999
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- Practice address
- 5891 Cedar Lake Rd S # 103
St Louis Park, MN 55416-1460 - Phone
- (952) 463-0600
- NPI assigned
- Jul 4, 2007
- 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 5
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| School Social Worker | 1041S0200X | 312442 | MN | |
| Mental Health Counselor | 101YM0800X | |||
| Psychologist | 103T00000X | |||
| Marriage & Family Therapist | 106H00000X | |||
| Clinical Social Worker | 1041C0700X | Primary |
Addresses
Primary practice location
5891 Cedar Lake Rd S # 103
St Louis Park, MN 55416-1460
Mailing address
5891 Cedar Lake Rd
#103
St Louis Park, MN 55416-1460
Phone (952) 463-0600
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 |
|---|---|---|---|
| 312442 | MN | MD | School Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1183507200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1525737600000",
"number": "1235337999",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5891 CEDAR LAKE RD",
"address_2": "#103",
"city": "ST LOUIS PARK",
"state": "MN",
"postal_code": "554161460",
"telephone_number": "952-463-0600"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5891 CEDAR LAKE RD S # 103",
"city": "ST LOUIS PARK",
"state": "MN",
"postal_code": "554161460",
"telephone_number": "952-463-0600"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GALLUCCI",
"first_name": "SUSAN",
"middle_name": "MARIE",
"name_prefix": "Ms.",
"credential": "L.I.C.S.W.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-07-04",
"last_updated": "2018-05-08",
"status": "A"
},
"taxonomies": [
{
"code": "1041S0200X",
"taxonomy_group": "",
"desc": "Social Worker, School",
"state": "MN",
"license": "312442",
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": false
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": null,
"license": null,
"primary": false
},
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": null,
"license": null,
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in St Louis Park, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.