Active NPI
Christina Marie Decker, LICSW
- Clinical Social Worker
- Minneapolis, MN
National Provider Identifier
1629258249
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 15015
- Practice address
- 2450 Riverside Ave
F196
Minneapolis, MN 55454-1450 - Phone
- (612) 273-4476
- Fax
- (612) 672-2691
- NPI assigned
- Nov 12, 2007
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 300221 | MN | |
| Clinical Social Worker | 1041C0700X | 15015 | MN | Primary |
Addresses
Primary practice location
2450 Riverside Ave
F196
Minneapolis, MN 55454-1450
Mailing address
2450 Riverside Ave
F196
Minneapolis, MN 55454-1450
Phone (612) 273-4476
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 |
|---|---|---|---|
| 300221 | MN | MD | Addiction (Substance Use Disorder) Counselor |
| 15015 | MN | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1194825600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1194825600000",
"number": "1629258249",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2450 RIVERSIDE AVE",
"address_2": "F196",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554541450",
"telephone_number": "612-273-4476",
"fax_number": "612-672-2691"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2450 RIVERSIDE AVE",
"address_2": "F196",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554541450",
"telephone_number": "612-273-4476",
"fax_number": "612-672-2691"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DECKER",
"first_name": "CHRISTINA",
"middle_name": "MARIE",
"name_prefix": "Ms.",
"credential": "LICSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-11-12",
"last_updated": "2007-11-12",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "MN",
"license": "300221",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MN",
"license": "15015",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Minneapolis, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.