Individual provider Active NPI

Naomi Elizabeth Erkenbrack, LICSW

  • Clinical Social Worker
  • Fargo, ND
National Provider Identifier
1396880571
Registry record updated Dec 8, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
3589 Issued in ND
Practice address
1112 Nodak Dr S
Fargo, ND 58103-2366
Phone
(701) 232-6224
Fax
(701) 232-4687
NPI assigned
Feb 21, 2007
Last updated
Dec 8, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 8, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Counselor 101Y00000X 3589 ND
Clinical Social Worker 1041C0700X 3589 ND Primary

Addresses

Primary practice location

1112 Nodak Dr S
Fargo, ND 58103-2366

Mailing address

1112 Nodak Dr S
Fargo, ND 58103-2366
Phone (701) 232-6224

Other identifiers 2

IdentifierTypeStateIssuer
470653OtherNDBEACON HEALTH OPTIONS
1455361MedicaidND

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ND
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
I20210114001491 ND Practitioner - Clinical Social Worker 3476966375 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2001
Medicare assignment
May accept Medicare assignment
Telehealth
Offers telehealth services
Group practices
Valley Christian Counseling Center IncGroup PAC ID 6709845654, 19 clinicians

Practice addresses (Care Compare)

1112 Nodak Dr S
Fargo, ND 58103-2333
Phone (701) 232-6224

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3589NDMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Valley Christian Counseling and Wellness Clinical CurrentSince Feb 1, 2020 Accepting new patients
Prairie St Johns Past Accepting new patients

Locations

1112 Nodak Dr S
Fargo, ND 58103
Phone (701) 232-6224

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1172016000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607385600000",
    "number": "1396880571",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1112 NODAK DR S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581032366",
            "telephone_number": "701-232-6224",
            "fax_number": "701-232-4687"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1112 NODAK DR S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581032366",
            "telephone_number": "701-232-6224",
            "fax_number": "701-232-4687"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ERKENBRACK",
        "first_name": "NAOMI",
        "middle_name": "ELIZABETH",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-21",
        "last_updated": "2020-12-08",
        "certification_date": "2020-12-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "ND",
            "license": "3589",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "ND",
            "license": "3589",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BEACON HEALTH OPTIONS",
            "identifier": "470653",
            "state": "ND"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1455361",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fargo, ND

Sources for this page

Verify at the official NPI Registry.