Active NPI
Elizabeth Grace Menaker, LCSW
- Clinical Social Worker
- Bozeman, MT
National Provider Identifier
1629493473
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 12272
- Practice address
- 1940 W Dickerson St
Suite 102
Bozeman, MT 59718-6851 - Phone
- (917) 207-9763
- Fax
- (406) 587-2292
- NPI assigned
- Mar 3, 2014
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 087906-1 | NY | |
| Clinical Social Worker | 1041C0700X | 12272 | MT | Primary |
Addresses
Primary practice location
1940 W Dickerson St
Suite 102
Bozeman, MT 59718-6851
Mailing address
1940 W Dickerson St
Suite 102
Bozeman, MT 59718-6851
Phone (917) 207-9763
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 |
|---|---|---|---|
| 087906-1 | NY | MD | Social Worker |
| 12272 | MT | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1393804800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1441670400000",
"number": "1629493473",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1940 W DICKERSON ST",
"address_2": "SUITE 102",
"city": "BOZEMAN",
"state": "MT",
"postal_code": "597186851",
"telephone_number": "917-207-9763",
"fax_number": "406-587-2292"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1940 W DICKERSON ST",
"address_2": "SUITE 102",
"city": "BOZEMAN",
"state": "MT",
"postal_code": "597186851",
"telephone_number": "917-207-9763",
"fax_number": "406-587-2292"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MENAKER",
"first_name": "ELIZABETH",
"middle_name": "GRACE",
"name_prefix": "Ms.",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-03-03",
"last_updated": "2015-09-08",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "NY",
"license": "087906-1",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MT",
"license": "12272",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bozeman, MT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.