Individual provider Active NPI

Gretchen Marie Laporta, LCSW

  • Clinical Social Worker
  • Monroe, NC
National Provider Identifier
1629057823
Registry record updated Apr 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
COO4418 Issued in NC
Practice address
1501 N Charlotte Ave # A239
Monroe, NC 28110-2525
Phone
(704) 283-2900
NPI assigned
Jan 16, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 10, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X COO4418 NC Primary

Addresses

Primary practice location

1501 N Charlotte Ave # A239
Monroe, NC 28110-2525

Mailing address

PO Box 690181
Mint Hill, NC 28227-7003
Phone (704) 283-2900

Other identifiers 1

IdentifierTypeStateIssuer
6005126MedicaidNC

Other names 1

  • Ms. Gretchen Marie Ellis Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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
I20050126000234 NC Practitioner - Clinical Social Worker 8729038948 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

6200 Creft Cir
Suite B
Indian Trail, NC 28079-6584
Phone (704) 283-2900

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
COO4418NCMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
The Therapy Place PLLC Clinical CurrentSince Mar 9, 2009 Accepting new patients
Peter Kronesphd,PA Past Accepting new patients

Locations

6200 Creft Cir
Ste B
Indian Trail, NC 28079
Phone (704) 283-2900

1501 N Charlotte Ave
#A239
Monroe, NC 28110
Phone (704) 283-2900

1501 N Charlotte Ave
Monroe, NC 28110
Phone (704) 283-2900

Organizations & group practices 2

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": "1137369600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712707200000",
    "number": "1629057823",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 690181",
            "city": "MINT HILL",
            "state": "NC",
            "postal_code": "282277003",
            "telephone_number": "704-283-2900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501 N CHARLOTTE AVE # A239",
            "city": "MONROE",
            "state": "NC",
            "postal_code": "281102525",
            "telephone_number": "704-283-2900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAPORTA",
        "first_name": "GRETCHEN",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-16",
        "last_updated": "2024-04-10",
        "certification_date": "2024-04-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "COO4418",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6005126",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "GRETCHEN",
            "last_name": "ELLIS",
            "middle_name": "MARIE",
            "prefix": "MS.",
            "credential": "LCSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Monroe, NC

Sources for this page

Verify at the official NPI Registry.