Brenden McGibbon, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

24309 Issued in MN

Practice address

2120 Park Ave
Minneapolis, MN 55404-3378

Phone

(612) 872-2000

Fax

(612) 871-1375

NPI assigned

Jul 6, 2018

Sex

Male

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1530835200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1556064000000",
    "number": "1871089482",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2120 PARK AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554043378",
            "telephone_number": "612-872-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2120 PARK AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554043378",
            "telephone_number": "612-872-2000",
            "fax_number": "612-871-1375"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2419 Nicollet Ave. S.",
            "address_purpose": "LOCATION",
            "city": "Minneapolis",
            "state": "MN",
            "postal_code": "55404",
            "country_code": "US",
            "telephone_number": "612-767-2054",
            "fax_number": "612-871-0432",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MCGIBBON",
        "first_name": "BRENDEN",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-07-06",
        "last_updated": "2019-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "24309",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1871089482",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Erin McFerson, DC
• Valcia McGann
• Elizabeth Rose McGarrity
• Marianne McGee, CNP
• Michele McGee
• Brittany McGibbon, PTA
• John McGill
• Megan McGill
• Kayla McGillicuddy, PT
• Jacquelyn McGinness

• Clinical Social Worker in Minneapolis, MN
• Providers in Minneapolis, 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 Apr 24, 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.

Verify at the official NPI Registry.