Cynthia Ann Rollo-Carlson, LICSW, LCSW,LADC
Individual provider Active NPI Clinical Social Worker · Walker, MN
NPI 1609450428 · NPPES record last updated Jan 16, 2025
Key facts
- NPI
- 1609450428
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 11704 (MN)
- Practice address
- 310 Railroad Ave
Walker, MN 56484 - Phone
- (218) 675-9170
- NPI assigned
- May 7, 2021
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 5
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: No · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230228001692 | MN | Practitioner - Clinical Social Worker | 0840663555 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 301020 | MN | MD | Addiction (Substance Use Disorder) Counselor |
| LCSW-3911 | HI | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Northern Pines Mental Health Center, Inc. | Current |
Accepting new patients | |
| Lake Country Associates, Inc. | Current |
Accepting new patients | |
| Northern Pines Mental Health Center, Inc. | Past |
Accepting new patients | |
| Peterson Medical Clinics, LLC | Past |
Accepting new patients | |
| Stellher Human Services, Inc. | Past |
Accepting new patients |
Locations
1906 5th Ave SE
Little Falls, MN 56345
Phone (320) 492-2946
515 Bridge St
Park Rapids, MN 56470
Phone (218) 252-0066
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 301020 | MN | |
| Clinical Social Worker | 1041C0700X | LCSW-3911 | HI | |
| Clinical Social Worker | 1041C0700X | 11704 | MN | Yes |
Addresses
Primary practice location
310 Railroad Ave
Walker, MN 56484
Mailing address
7561 Front St NW
Walker, MN 56484-2003
Phone (808) 345-3205
Other practice location 1
7561 Front St NW
Walker, MN 56484-2003
Phone (808) 345-3205
Other providers in Walker, MN
- Michael Todd Pederson
- William M Petersen
- Jennifer Lee Peterson
- Kristen Richter
- Alyssa Sharon Robley
- Rachel Rowenhorst
- Sanford Health of Northern Minnesota
- Lisha Schultz
- Jessica Shannon
- Shingobee Island Lodge Incorporated
All providers in Walker, 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 Jan 16, 2025. 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).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.