Dayne Marcus Bartlett, MSW, LICSW, LADC
Individual provider Active NPI Clinical Social Worker · Northfield, MN
NPI 1457950503 · NPPES record last updated Jul 19, 2024
Key facts
- NPI
- 1457950503
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 26497 (MN)
- Practice address
- 1211 Winona St
Northfield, MN 55057-2830 - Phone
- (507) 382-8188
- NPI assigned
- Oct 20, 2020
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210317002196 | MN | Practitioner - Clinical Social Worker | 8527474501 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 304138 | MN | MD | Addiction (Substance Use Disorder) Counselor |
| 26497 | MN | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Create Meaning LLC | Clinical | Current |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 304138 | MN | |
| Clinical Social Worker | 1041C0700X | 26497 | MN | Yes |
Addresses
Primary practice location
1211 Winona St
Northfield, MN 55057-2830
Mailing address
1211 Winona St
Northfield, MN 55057-2830
Phone (507) 382-8188
Other practice location 1
2324 University Ave W
Saint Paul, MN 55114-1843
Phone (651) 644-4100
Other providers in Northfield, MN
- Dana Marija Balukas
- Martha Barck
- Baremed PLLC
- Erin Barnett
- Claire L Bartlett
- Deborah Sue Bauer
- Cynthia L Baumgartner
- Patricia Lea Beaudoin
- Julie Lynn Beckmann
- Ryan W Behrens
All providers in Northfield, MN · Clinical Social Worker in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 19, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.