Andrea Lee Dalzell, MSW, LICSW
Individual provider Active NPI Clinical Social Worker · Brainerd, MN
NPI 1578076154 · NPPES record last updated Nov 6, 2017
Key facts
- NPI
- 1578076154
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 24265 (MN)
- Practice address
- 823 Maple St
Brainerd, MN 56401-3770 - Phone
- (218) 454-7205
- NPI assigned
- Nov 6, 2017
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Clinical Social Worker
- Education
- Other, 2014
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- The Therapist
Practice addresses (Care Compare)
401 W Laurel St
Suite C
Brainerd, MN 56401-3970
Phone (218) 454-3288
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 |
|---|---|---|---|---|
| I20171221002021 | MN | Practitioner - Clinical Social Worker | 5395003222 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| The Therapist | Current |
Accepting new patients | |
| Northern Pines Mental Health Center, Inc. | Past |
Accepting new patients |
Locations
401 W Laurel St
Ste C
Brainerd, MN 56401
Phone (218) 454-3288
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 24265 | MN | Yes |
Addresses
Primary practice location
823 Maple St
Brainerd, MN 56401-3770
Mailing address
916 S 7TH St
Brainerd, MN 56401-4035
Phone (218) 851-6906
Other providers in Brainerd, MN
- Crow Wing County Social Services
- Michael John Curran
- Kelsey Dagen
- Leif Michael Dahleen
- Dana Marie Dally-Cleys
- Alyssa Louise Daniels
- Matthew Danielson
- Christy Lee Dano
- Julia Elizabeth Davick
- Greg J Davis
All providers in Brainerd, 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 Nov 6, 2017. 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).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.