Individual provider Active NPI

Mary Monique Sebring, LICSW

  • Clinical Social Worker
  • Saint Peter, MN
National Provider Identifier
1306935812
Registry record updated Sep 3, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
12895 Issued in MN
Practice address
1306 Marshall St
Saint Peter, MN 56082-4500
Phone
(507) 931-8040
Fax
(507) 931-8060
NPI assigned
Oct 12, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 3, 2021

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 12895 MN Primary

Addresses

Primary practice location

1306 Marshall St
Saint Peter, MN 56082-4500

Mailing address

1306 Marshall St
Saint Peter, MN 56082-4500
Phone (507) 931-8040

Other identifiers 8

IdentifierTypeStateIssuer
42G17AVOtherMNBCBS MN
990991042538OtherMNBHP PREFERRED 1
56308-A002OtherMNTRI WEST
221985900MedicaidMN
62-76940OtherMNMEDICA UBH
HP39762OtherMNHEALTH PARTNERS
113219OtherMNU CARE
31002005OtherMNPRIME WEST

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
I20210528001423 MN Practitioner - Clinical Social Worker 3779982426 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1994
Medicare assignment
May accept Medicare assignment
Group practices
Counseling Services of Southern Minnesota, IncGroup PAC ID 5890696868, 9 clinicians

Practice addresses (Care Compare)

1306 Marshall St
Saint Peter, MN 56082-4500
Phone (507) 931-8040

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Counseling Services of Southern Minnesota, Inc Clinical CurrentSince Apr 13, 2021 Accepting new patients
Village Family Service Center Past Accepting new patients

Locations

1306 Marshall St
Saint Peter, MN 56082
Phone (507) 931-8040

Organizations & group practices 2

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": "1160611200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1630627200000",
    "number": "1306935812",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1306 MARSHALL ST",
            "city": "SAINT PETER",
            "state": "MN",
            "postal_code": "560824500",
            "telephone_number": "507-931-8040",
            "fax_number": "507-931-8060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1306 MARSHALL ST",
            "city": "SAINT PETER",
            "state": "MN",
            "postal_code": "560824500",
            "telephone_number": "507-931-8040",
            "fax_number": "507-931-8060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SEBRING",
        "first_name": "MARY",
        "middle_name": "MONIQUE",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-12",
        "last_updated": "2021-09-03",
        "certification_date": "2021-09-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "12895",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS MN",
            "identifier": "42G17AV",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BHP PREFERRED 1",
            "identifier": "990991042538",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRI WEST",
            "identifier": "56308-A002",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "221985900",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA UBH",
            "identifier": "62-76940",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PARTNERS",
            "identifier": "HP39762",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "U CARE",
            "identifier": "113219",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PRIME WEST",
            "identifier": "31002005",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Peter, MN

Sources for this page

Verify at the official NPI Registry.