Individual provider Active NPI

Elizabeth Jean Kalmon, LICSW

  • Clinical Social Worker
  • Saint Paul, MN
National Provider Identifier
1245052737
Registry record updated Oct 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
25408 Issued in MN
Practice address
166 4TH St E
Saint Paul, MN 55101-2737
Phone
(651) 389-4680
NPI assigned
Oct 28, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 28, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 25408 MN Primary

Addresses

Primary practice location

166 4TH St E
Saint Paul, MN 55101-2737

Mailing address

166 4TH St E
Saint Paul, MN 55101-2737
Phone (651) 350-8752

Other names 1

  • Elizabeth Jean Theodora Professional name

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20250429002823 MN Practitioner - Clinical Social Worker 0547786899 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
25408MNMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
South Metro Human Services Clinical CurrentSince Feb 23, 2025 Accepting new patients

Locations

166 4th St E
Ste 200
Saint Paul, MN 55101
Phone (651) 291-1979

166 4th St E
Saint Paul, MN 55101
Phone (651) 292-2009

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": "1730073600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730073600000",
    "number": "1245052737",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "166 4TH ST E",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551012737",
            "telephone_number": "651-350-8752"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "166 4TH ST E",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551012737",
            "telephone_number": "651-389-4680"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KALMON",
        "first_name": "ELIZABETH",
        "middle_name": "JEAN",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-10-28",
        "last_updated": "2024-10-28",
        "certification_date": "2024-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "25408",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ELIZABETH",
            "last_name": "THEODORA",
            "middle_name": "JEAN",
            "credential": "LICSW",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in Saint Paul, MN

Sources for this page

Verify at the official NPI Registry.