Active NPI
Angela Makeba Myers, LISCW
- Clinical Social Worker
- Saint Paul, MN
National Provider Identifier
1932607199
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 24391
- Practice address
- 393 Dunlap St N Ste 736
Saint Paul, MN 55104-4205 - Phone
- (612) 289-5656
- Fax
- (651) 925-0278
- NPI assigned
- Jan 23, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 24391 | MN | Primary |
Addresses
Primary practice location
393 Dunlap St N Ste 736
Saint Paul, MN 55104-4205
Mailing address
393 Dunlap St N Ste 736
Saint Paul, MN 55104-4205
Phone (612) 289-5656
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 46-3824598 | Other | MN | TAX ID |
| 1780011510 | Other | MN | NPI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 24391 | MN | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Roots Recovery | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Substance Use Disorder Rehabilitation Clinic/Center
- Saint Paul, MN
- NPI 1104309434
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1516665600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1516665600000",
"number": "1932607199",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "393 DUNLAP ST N STE 736",
"city": "SAINT PAUL",
"state": "MN",
"postal_code": "551044205",
"telephone_number": "612-289-5656",
"fax_number": "651-925-0278"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "393 DUNLAP ST N STE 736",
"city": "SAINT PAUL",
"state": "MN",
"postal_code": "551044205",
"telephone_number": "612-289-5656",
"fax_number": "651-925-0278"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MYERS",
"first_name": "ANGELA",
"middle_name": "MAKEBA",
"credential": "LISCW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-01-23",
"last_updated": "2018-01-23",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MN",
"license": "24391",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TAX ID",
"identifier": "46-3824598",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NPI",
"identifier": "1780011510",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Saint Paul, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.