Mariah Pundsack, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

22157 Issued in MN

Practice address

823 Maple St
Brainerd, MN 56401-3770

Phone

(218) 454-3848

NPI assigned

Aug 23, 2018

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

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.

• Northern Pines Mental Health Center, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Little Falls, MN
  • NPI 1013904051
  NPD (past)

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

{
    "created_epoch": "1534982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634601600000",
    "number": "1780165274",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22605 440TH ST",
            "city": "FREEPORT",
            "state": "MN",
            "postal_code": "563319620",
            "telephone_number": "320-295-6364"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "823 MAPLE ST",
            "city": "BRAINERD",
            "state": "MN",
            "postal_code": "564013770",
            "telephone_number": "218-454-3848"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "22605 440th St",
            "address_purpose": "LOCATION",
            "city": "Freeport",
            "state": "MN",
            "postal_code": "563319620",
            "country_code": "US",
            "telephone_number": "320-296-6364",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PUNDSACK",
        "first_name": "MARIAH",
        "credential": "LICSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-08-23",
        "last_updated": "2021-10-19",
        "certification_date": "2021-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "22157",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robert O Posch, M.D.
• Private Healthcare Facilities
• PRS Transportation Services, Inc.
• Psychology Services of Minnesota, PLLC
• Brianna Lynn Pulkrabek, PHARM D
• Adam Lee Purcell, APRN, CNP
• Bradley James Qualey, MD
• Christina Annette Quigley
• Rainbow of Health Physical Therapy, Inc.
• Rainbow Therapeutics, Inc.

• Clinical Social Worker in Brainerd, MN
• Providers in Brainerd, 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 Oct 19, 2021; 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.