Individual provider Active NPI

Cheryl Goldenberg, PSYD, LP

  • Clinical Psychologist
  • Saint Louis Park, MN
National Provider Identifier
1598865354
Registry record updated Oct 11, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
4072 Issued in MN
Practice address
5100 Gamble Dr Ste 100
Saint Louis Park, MN 55416-1582
Phone
(952) 541-2500
Fax
(952) 541-2539
NPI assigned
Sep 22, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 11, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 4072 MN Primary

Addresses

Primary practice location

5100 Gamble Dr Ste 100
Saint Louis Park, MN 55416-1582

Mailing address

8170 33Rd Ave
Ms: 21110Q
Bloomington, MN 55425-4516
Phone (952) 541-2500

Other identifiers 1

IdentifierTypeStateIssuer
518514900MedicaidMN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
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
I20160809001750 MN Practitioner - Clinical Psychologist 1951695212 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Group Health IncGroup PAC ID 1759293954, 1,627 clinicians

Practice addresses (Care Compare)

8600 Nicollet Ave
Bloomington, MN 55420-2824
Phone (952) 884-1148

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Group Health, Inc. CurrentSince Sep 26, 2016 Accepting new patients
Group Health, Inc. CurrentSince Sep 26, 2016 Accepting new patients
Group Health, Inc. Current Accepting new patients

Locations

8170 33rd Ave S
#21110Q
Minneapolis, MN 55425
Phone (952) 883-5375

8600 Nicollet Ave S
Minneapolis, MN 55420
Phone (952) 887-6600

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1158883200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1476144000000",
    "number": "1598865354",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8170 33RD AVE",
            "address_2": "MS: 21110Q",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554254516",
            "telephone_number": "952-541-2500",
            "fax_number": "952-541-2539"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5100 GAMBLE DR STE 100",
            "city": "SAINT LOUIS PARK",
            "state": "MN",
            "postal_code": "554161582",
            "telephone_number": "952-541-2500",
            "fax_number": "952-541-2539"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOLDENBERG",
        "first_name": "CHERYL",
        "credential": "PSYD, LP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-22",
        "last_updated": "2016-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MN",
            "license": "4072",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "518514900",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis Park, MN

Sources for this page

Verify at the official NPI Registry.