Maryjo Melander, LICSW

Primary specialty

Social WorkerTaxonomy code 104100000X

License

LICSW 17391 Issued in MN

Practice address

1960 Cliff Lake Road
Suite 129-179
Eagan, MN 55122

Phone

(651) 505-5349

NPI assigned

Jul 13, 2009

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

Opted out of Medicare

Yes, effective Dec 28, 2023 through Dec 28, 2027

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• MJ Counseling, LLC

  • Clinical Social Worker
  • Eagan, MN
  • NPI 1952016768
  NPD Authorized official
• True North Therapy LLC

  • Community/Behavioral Health Agency
  • Lakeville, MN
  • NPI 1649715400
  NPD (past)

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

{
    "created_epoch": "1247443200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1674000000000",
    "number": "1770712713",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1960 CLIFF LAKE ROAD",
            "address_2": "SUITE 129-179",
            "city": "EAGAN",
            "state": "MN",
            "postal_code": "55122",
            "telephone_number": "651-505-5349"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1960 CLIFF LAKE ROAD",
            "address_2": "SUITE 129-179",
            "city": "EAGAN",
            "state": "MN",
            "postal_code": "55122",
            "telephone_number": "651-505-5349"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MELANDER",
        "first_name": "MARYJO",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-07-13",
        "last_updated": "2023-01-18",
        "certification_date": "2023-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MN",
            "license": "LICSW 17391",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jachai Dushawn McNeal
• Allison McVay-Steer, NP
• Medilift Transport
• Krystal M Medley, APRN
• Michelle Elizabeth Meehan, MA LPCC
• Mercy Health Services LLC
• Mercy Living
• Talaya Gail Merrell
• Metro Doula Agency, LLC
• Metropolitan Pediatric Dental Associates, LTD

• Social Worker in Eagan, MN
• Providers in Eagan, MN by specialty
• Social Worker in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.