Individual provider Active NPI

Elizabeth Ann Gary, LICSW

  • Clinical Social Worker
  • Saint Cloud, MN
National Provider Identifier
1609073659
Registry record updated Nov 18, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
18732 Issued in MN
Practice address
4801 Veterans Drive
St. Cloud, MN 56303-2015
Phone
(320) 252-1670
NPI assigned
Jul 2, 2007
Last updated
Nov 18, 2009By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 18, 2009

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 50132 TX
Clinical Social Worker 1041C0700X 18732 MN Primary

Addresses

Primary practice location

4801 Veterans Drive
St. Cloud, MN 56303-2015

Mailing address

15 Summit Ave S
Sauk Rapids, MN 56379-1913
Phone (817) 480-3741

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)
Not enrolled

State licenses

LicenseStateTypeSpecialty
50132TXMDClinical Social Worker
18732MNMDFamily Medicine Physician

NPI Registry JSON

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

{
    "created_epoch": "1183334400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1258502400000",
    "number": "1609073659",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 SUMMIT AVE S",
            "city": "SAUK RAPIDS",
            "state": "MN",
            "postal_code": "563791913",
            "telephone_number": "817-480-3741"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4801 VETERANS DRIVE",
            "city": "ST. CLOUD",
            "state": "MN",
            "postal_code": "563032015",
            "telephone_number": "320-252-1670"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GARY",
        "first_name": "ELIZABETH",
        "middle_name": "ANN",
        "credential": "LICSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-07-02",
        "last_updated": "2009-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "TX",
            "license": "50132",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "18732",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Cloud, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.