Mary Kelleen Bermensolo, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LCSW492 Issued in ID

Practice address

410 S Orchard St Ste 164
Boise, ID 83705-1295

Phone

(208) 412-6683

Fax

(208) 279-0481

NPI assigned

Jan 9, 2007

Last updated

Sep 23, 2026By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Enrolled in ID

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

Specialty

Clinical Social Worker

Education

Other, 1984

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1168300800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1790121600000",
    "number": "1659420693",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "410 S ORCHARD ST STE 164",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837051295",
            "telephone_number": "208-412-6683",
            "fax_number": "208-279-0481"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "410 S ORCHARD ST STE 164",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837051295",
            "telephone_number": "208-412-6683",
            "fax_number": "208-279-0481"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERMENSOLO",
        "first_name": "MARY",
        "middle_name": "KELLEEN",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-09",
        "last_updated": "2026-09-23",
        "certification_date": "2026-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "ID",
            "license": "LCSW492",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bryanna M Berish, PNP
• Ryan Berkseth, PHARMD
• Joshua Berlat, MD
• Claudia Jae Bermensolo, RRT
• Karen Bermensolo, RN, BSN
• Maria Carmen Bernabe
• Madeline Francesca Melillo Bernardo
• Berndt and Associates in Psychcare LLC
• Madison Nicole Bernhardt
• Chantelle Bernier

• Clinical Social Worker in Boise, ID
• Providers in Boise, ID by specialty
• Clinical Social Worker in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.