Active NPI
Mary Lou Mattson, LCSW, DBTC
- Clinical Social Worker
- Woodbury, MN
National Provider Identifier
1629407689
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 7778-123
- Practice address
- 10300 City Walk Dr Unit 431
Woodbury, MN 55129-6953 - Phone
- (920) 312-1477
- NPI assigned
- Nov 10, 2013
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 7778-123 | WI | Primary |
Addresses
Primary practice location
10300 City Walk Dr Unit 431
Woodbury, MN 55129-6953
Mailing address
10300 City Walk Dr Unit 431
Woodbury, MN 55129-6953
Phone (920) 312-1477
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
| License | State | Type | Specialty |
|---|---|---|---|
| 7778-123 | WI | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Behavioral Health Specialists (de), P.a. | Clinical | Past | Accepting new patients |
Organizations & group practices 1
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": "1384041600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1384041600000",
"number": "1629407689",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10300 CITY WALK DR UNIT 431",
"city": "WOODBURY",
"state": "MN",
"postal_code": "551296953",
"telephone_number": "920-312-1477"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10300 CITY WALK DR UNIT 431",
"city": "WOODBURY",
"state": "MN",
"postal_code": "551296953",
"telephone_number": "920-312-1477"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATTSON",
"first_name": "MARY",
"middle_name": "LOU",
"credential": "LCSW, DBTC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-11-10",
"last_updated": "2013-11-10",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "WI",
"license": "7778-123",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Woodbury, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.