Krysta Victoria Mazur, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

23468 Issued in MN

Practice address

7954 University Ave NE
Fridley, MN 55432-1860

Phone

(763) 780-3036

Fax

(763) 780-0784

NPI assigned

Jun 28, 2019

Last updated

May 6, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Specialty

Clinical Social Worker

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Optum Behavioral Care of Colorado PCGroup PAC ID 0941648463, 196 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Optum Behavioral Care of Colorado, P.C.

  dba Northern Psychiatric Associates of Minnesota

  • Clinical Psychologist
  • Baxter, MN
  • NPI 1124898556
  Medicare reassignment Care Compare group NPD
• Care Clinics, LLC

  • Psychologist
  • St Louis Park, MN
  • NPI 1851716245
  NPD
• Optum Behavioral Care of Colorado, P.C.

  dba DBT-PTSD Specialists of Minnesota

  • Clinical Psychologist
  • Minneapolis, MN
  • NPI 1053181487
  NPD
• Optum Behavioral Care of Colorado, P.C.

  • Clinical Social Worker
  • De Pere, WI
  • NPI 1396622494
  NPD
• Lee Carlson Center for Mental Health and Well-Being

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Fridley, MN
  • NPI 1457455057
  NPD (past)
• Optum Behavioral Care of Colorado PC

  dba Care Counseling of Minnesota

  • Psychologist
  • Edina, MN
  • NPI 1336967561
  NPD (past)

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

{
    "created_epoch": "1561680000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714953600000",
    "number": "1275194391",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4100 BERKSHIRE LN N STE 250",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554463813",
            "telephone_number": "612-688-3701",
            "fax_number": "612-223-8899"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7954 UNIVERSITY AVE NE",
            "city": "FRIDLEY",
            "state": "MN",
            "postal_code": "554321860",
            "telephone_number": "763-780-3036",
            "fax_number": "763-780-0784"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAZUR",
        "first_name": "KRYSTA",
        "middle_name": "VICTORIA",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-06-28",
        "last_updated": "2024-05-06",
        "certification_date": "2024-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "23468",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dorothy Mattson
• Lisa R Mattson, M.D.
• John David Matzoll, ATC
• Marc Maus, LICSW
• Amy Kirsten Maynard, RN, MS, CCCRN, CCNS
• Dienabou Mboup
• Melissa Otilia McCarty, PSYD, LP
• Tina Marie McCarty, O.D.
• Emily Marie McConnell, DNP
• Shannon E McCutcheon, NP

• Clinical Social Worker in Fridley, MN
• Providers in Fridley, 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 May 6, 2024; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.