Deirdre McKiernan, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

15301 Issued in MN

Practice address

4748 Chicago Ave Ste 1
Minneapolis, MN 55407

Phone

(612) 821-1920

Fax

(612) 821-1919

NPI assigned

Nov 1, 2006

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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

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.

• Child and Family Specialty Clinic P a

  • Mental Health Counselor
  • Minneapolis, MN
  • NPI 1376765529

  Clinical

  NPD (past)

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1533513600000",
    "number": "1346327574",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4748 CHICAGO AVE STE 1",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554074311",
            "telephone_number": "612-821-1920",
            "fax_number": "612-821-1919"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4748 CHICAGO AVE STE 1",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "55407",
            "telephone_number": "612-821-1920",
            "fax_number": "612-821-1919"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCKIERNAN",
        "first_name": "DEIRDRE",
        "name_prefix": "Ms.",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-01",
        "last_updated": "2018-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "15301",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "806980800",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kathryn Elizabeth McKenzie, PA-C
• Shemica Marie McKenzie
• Somer Lynn McKenzie, MSW
• Esther C McKeown, NP
• Alison McKernan, LICSW
• Amy Elizabeth McKinley, MA, LPCC
• James McKinley, CRNA
• Saundra Lynn McKissic, LPN
• Robert E McKlveen, M.D.
• Shannon Christine McKnight

• Clinical Social Worker in Minneapolis, MN
• Providers in Minneapolis, 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 Aug 6, 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.

Verify at the official NPI Registry.