Active NPI
Michael Edward Rivard, LICSW
- Clinical Social Worker
- Sartell, MN
National Provider Identifier
1720228356
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 11796
- Practice address
- 313 22ND Ave N
Sartell, MN 56377-2467 - Phone
- (320) 224-1522
- Fax
- (320) 255-7011
- NPI assigned
- Feb 22, 2009
- Sex
- Male
- 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 | 11796 | MN | Primary |
Addresses
Primary practice location
313 22ND Ave N
Sartell, MN 56377-2467
Mailing address
902 Highway 15 S Ste 200
Hutchinson, MN 55350-3506
Phone (320) 587-4127
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 |
|---|---|---|---|
| 11796 | MN | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Willow Lake Mental Health Center | 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.
-
- Clinical Social Worker
- Hutchinson, MN
- NPI 1063738508
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1235260800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1235260800000",
"number": "1720228356",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "902 HIGHWAY 15 S STE 200",
"city": "HUTCHINSON",
"state": "MN",
"postal_code": "553503506",
"telephone_number": "320-587-4127",
"fax_number": "320-587-3886"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "313 22ND AVE N",
"city": "SARTELL",
"state": "MN",
"postal_code": "563772467",
"telephone_number": "320-224-1522",
"fax_number": "320-255-7011"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RIVARD",
"first_name": "MICHAEL",
"middle_name": "EDWARD",
"name_prefix": "Mr.",
"credential": "LICSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-02-22",
"last_updated": "2009-02-22",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MN",
"license": "11796",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sartell, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.