Bennett Brandvold, MSW, LGSW
Individual provider Active NPI Social Worker · New Hope, MN
NPI 1891424735 · NPPES record last updated Jun 7, 2022
Key facts
- NPI
- 1891424735
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Social Worker 104100000X
- License
- 28626 (MN)
- Practice address
- 4900 Highway 169 N Ste 220
New Hope, MN 55428-4058 - Phone
- (612) 517-1577
- NPI assigned
- Jun 7, 2022
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
- 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 |
|---|---|---|---|---|
| I20250703002208 | MN | Practitioner - Clinical Social Worker | 5991219784 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 28626 | MN | MD | Advanced Heart Failure and Transplant Cardiology Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 28626 | MN | Yes |
Addresses
Primary practice location
4900 Highway 169 N Ste 220
New Hope, MN 55428-4058
Mailing address
4900 Highway 169 N Ste 220
New Hope, MN 55428-4058
Phone (612) 517-1577
Other providers in New Hope, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 7, 2022. 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.