Fathi Abdullahi Kofiro, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

27112 Issued in MN

Practice address

8030 Old Cedar Ave S
Bloomington, MN 55425-1213

Phone

(763) 209-8263

NPI assigned

Apr 16, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

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.

• Daryeel Therapy LLC

  • Clinical Social Worker
  • Bloomington, MN
  • NPI 1891523445
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1618531200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753228800000",
    "number": "1649851197",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1509 W 86TH ST",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554312071",
            "telephone_number": "763-209-8263"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8030 OLD CEDAR AVE S",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554251213",
            "telephone_number": "763-209-8263"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOFIRO",
        "first_name": "FATHI",
        "middle_name": "ABDULLAHI",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-04-16",
        "last_updated": "2025-07-23",
        "certification_date": "2025-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "27112",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Whitney Lynn Knight
• Jordan Jace Knowlton-Key, DC
• Patrick Koch, MA
• Stephanie Lynn Koch
• Sara Beth Koepp, PT
• Chad M Kofoed, DPT
• Karen M Kohl, GNP
• Farhat Kokan, MD
• Kenneth Alyn Kokkinen, D.D.S.
• Amy E Kolar, MD

• Clinical Social Worker in Bloomington, MN
• Providers in Bloomington, MN by specialty
• Clinical Social Worker in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.