Mary A Larocque, MSW LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

34001252A Issued in IN

Practice address

7806 W Jefferson Blvd Ste C
Fort Wayne, IN 46804-4180

Phone

(260) 203-4188

Fax

(260) 203-5136

NPI assigned

Aug 4, 2006

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

Other identifiers 1

Other names 1

• Miss Mary A Klinedorf Former name

Medicare fee-for-service enrollment

Enrolled in IN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 1972

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Von Bargen Associates IncGroup PAC ID 8426011792, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/20439/brand/1/csg/1/fhir/r4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Von Bargen Associates, Inc.

  dba Directions In Aging

  • Clinical Psychologist
  • Fort Wayne, IN
  • NPI 1366492043
  Medicare reassignment Care Compare group
• Pancner Psychiatric Associates, PC

  • Psychologist
  • Fort Wayne, IN
  • NPI 1801019096
  Medicare reassignment NPD
• Psychiatric Services P C

  • Psychiatry Physician
  • Fort Wayne, IN
  • NPI 1194913228
  Medicare reassignment
• Herbert P. Trier, M.D.

  dba Associated Psychiatric Services

  • Psychiatry Physician
  • Fort Wayne, IN
  • NPI 1477722197

  Clinical

  NPD (past)

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

{
    "created_epoch": "1154649600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663545600000",
    "number": "1851309876",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7311A W JEFFERSON BLVD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468046237",
            "telephone_number": "260-471-8033",
            "fax_number": "260-471-8107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7806 W JEFFERSON BLVD STE C",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468044180",
            "telephone_number": "260-203-4188",
            "fax_number": "260-203-5136"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAROCQUE",
        "first_name": "MARY",
        "middle_name": "A",
        "name_prefix": "Ms.",
        "credential": "MSW LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-04",
        "last_updated": "2022-09-19",
        "certification_date": "2022-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IN",
            "license": "34001252A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200800080",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARY",
            "last_name": "KLINEDORF",
            "middle_name": "A",
            "prefix": "MISS",
            "credential": "MSW LCSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jennifer Lapsley, RN
• Amabel Pia A Lapuebla, M.D.
• Colleen Largent, O.D.
• Pierce Larke, PA
• Esther Larkey
• James Larowe, ODT
• Julie Larranaga
• Marc Richard Larsen-Hallock, DO
• Angela P Lasalle, MD
• Christopher W Lasalle, MD

• Clinical Social Worker in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Clinical Social Worker in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.