Active NPI
Diane Marie Perry, LICSW
- Clinical Social Worker
- Brooklyn Center, MN
National Provider Identifier
1598486177
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 11584
- Practice address
- 6200 Shingle Creek Pkwy Ste 250
Brooklyn Center, MN 55430-2107 - Phone
- (612) 578-3976
- Fax
- (763) 544-0984
- NPI assigned
- Sep 12, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 11584 | MN | Primary |
Addresses
Primary practice location
6200 Shingle Creek Pkwy Ste 250
Brooklyn Center, MN 55430-2107
Mailing address
210 Athens Way Ste 200
Nashville, TN 37228-1308
Phone (612) 578-3976
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11584 | MN | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ilbnc, P.a. | Past | Accepting new patients |
Organizations & group practices 1
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.
-
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- Bloomington, MN
- NPI 1023001815
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1662940800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1662940800000",
"number": "1598486177",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "210 ATHENS WAY STE 200",
"city": "NASHVILLE",
"state": "TN",
"postal_code": "372281308",
"telephone_number": "612-578-3976"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6200 SHINGLE CREEK PKWY STE 250",
"city": "BROOKLYN CENTER",
"state": "MN",
"postal_code": "554302107",
"telephone_number": "612-578-3976",
"fax_number": "763-544-0984"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PERRY",
"first_name": "DIANE",
"middle_name": "MARIE",
"credential": "LICSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-09-12",
"last_updated": "2022-09-12",
"certification_date": "2022-09-11",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MN",
"license": "11584",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brooklyn Center, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.