Joanne M Berthelsen, MSW, LCSW, SACIT
Individual provider Active NPI Clinical Social Worker · Baileys Harbor, WI
NPI 1831614049 · NPPES record last updated Feb 16, 2023
Key facts
- NPI
- 1831614049
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 8705-123 (WI)
- Practice address
- 3011 Wind Song LN
Baileys Harbor, WI 54202-9164 - Phone
- (262) 235-2350
- Fax
- (262) 804-8132
- NPI assigned
- Aug 8, 2017
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20171018003594 | WI | Practitioner - Clinical Social Worker | 2062788078 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 18294-130 | WI | MD | Addiction (Substance Use Disorder) Counselor |
| SW18876 | FL | MD | Clinical Social Worker |
| 6801112408 | MI | MD | Clinical Social Worker |
| 8705-123 | WI | MD | Clinical Social Worker |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 18294-130 | WI | |
| Mental Health Counselor | 101YM0800X | 8705-123 | WI | |
| Clinical Social Worker | 1041C0700X | SW18876 | FL | |
| Clinical Social Worker | 1041C0700X | 6801112408 | MI | |
| Clinical Social Worker | 1041C0700X | 8705-123 | WI | Yes |
Addresses
Primary practice location
3011 Wind Song LN
Baileys Harbor, WI 54202-9164
Mailing address
3011 Wind Song LN
Baileys Harbor, WI 54202-9164
Phone (262) 235-2350
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100071305 | Medicaid | WI |
Other names
- Joanne M Anderson
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | joanne@joanneberthelsenlcsw.com |
Other providers in Baileys Harbor, WI
All providers in Baileys Harbor, WI · Clinical Social Worker in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 16, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.