Marcy Beth Buckner, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

11250 Issued in MN

Practice address

3915 Golden Valley Road
Courage Center
Golden Valley, MN 55422-4298

Phone

(763) 520-0463

Fax

(763) 520-0355

NPI assigned

Jun 20, 2006

Last updated

Jul 8, 2007By 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

Other identifiers 4

Other names 1

• Marcy Beth Polan Former name

Medicare fee-for-service enrollment

Enrolled in VT

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, 1987

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1150761600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1568408672",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3915 GOLDEN VALLEY ROAD",
            "address_2": "COURAGE CENTER",
            "city": "GOLDEN VALLEY",
            "state": "MN",
            "postal_code": "554224298",
            "telephone_number": "763-520-0463",
            "fax_number": "763-520-0355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3915 GOLDEN VALLEY ROAD",
            "address_2": "COURAGE CENTER",
            "city": "GOLDEN VALLEY",
            "state": "MN",
            "postal_code": "554224298",
            "telephone_number": "763-520-0463",
            "fax_number": "763-520-0355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUCKNER",
        "first_name": "MARCY",
        "middle_name": "BETH",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-20",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "11250",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED ONE",
            "identifier": "963371008127",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UBH",
            "identifier": "6236582",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHPARTNERS",
            "identifier": "HP38889",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS MINNESOTA",
            "identifier": "63D31BU",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARCY",
            "last_name": "POLAN",
            "middle_name": "BETH",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Melinda Brown, LICSW
• Rhoda Brown
• Tanya Brown
• Shari Kay Bruning, D.D.S.
• Saundra Bryant-Lamb, LICSW
• David John Buechel II, DC
• Buice Behavioral Healthcare Consultants Inc
• Bunka Enterprise L.L.C. (ARCpoint Labs of Golden Valley)
• Anya Karmel Chappell Bunney, OTR/L
• Michelle Burke, COTA

• Clinical Social Worker in Golden Valley, MN
• Providers in Golden Valley, 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 Jul 8, 2007; 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.