Active NPI
Andrea Susan Robertson, MSW, LICSW
- Clinical Social Worker
- Lake Elmo, MN
National Provider Identifier
1720304991
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 14256
- Practice address
- 8530 Eagle Point Blvd
Suite 150
Lake Elmo, MN 55042-8649 - Phone
- (612) 701-0477
- NPI assigned
- Apr 13, 2010
- Sex
- Female
- Sole proprietor
- No
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 | 14256 | MN | Primary |
Addresses
Primary practice location
8530 Eagle Point Blvd
Suite 150
Lake Elmo, MN 55042-8649
Mailing address
1035 Smith Ave S
West St Paul, MN 55118-1106
Phone (651) 552-7758
Other practice location 1
790 Cleveland Ave S
Saint Paul, MN 55116-3858
Phone (651) 690-0953
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720304991 | Medicaid | MN |
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Midwest Center for Personal & Family Development PA | Past | Accepting new patients | |
| Pathway Virtu-Health | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Saint Paul, MN
- NPI 1285730903
-
- Family Nurse Practitioner
- Shoreview, MN
- NPI 1073134284
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1271116800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1548201600000",
"number": "1720304991",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1035 SMITH AVE S",
"city": "WEST ST PAUL",
"state": "MN",
"postal_code": "551181106",
"telephone_number": "651-552-7758"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8530 EAGLE POINT BLVD",
"address_2": "SUITE 150",
"city": "LAKE ELMO",
"state": "MN",
"postal_code": "550428649",
"telephone_number": "612-701-0477"
}
],
"practiceLocations": [
{
"address_1": "790 Cleveland Ave S",
"address_purpose": "LOCATION",
"city": "Saint Paul",
"state": "MN",
"postal_code": "551163858",
"country_code": "US",
"telephone_number": "651-690-0953",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "ROBERTSON",
"first_name": "ANDREA",
"middle_name": "SUSAN",
"credential": "MSW, LICSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-04-13",
"last_updated": "2019-01-23",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MN",
"license": "14256",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1720304991",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lake Elmo, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.