Active NPI
Colleen M Brazil, LCSW
- Social Worker
- Council Bluffs, IA
National Provider Identifier
1962585489
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- LCSW 1749
- Practice address
- 500 Willow Ave
Suite 305
Council Bluffs, IA 51503-0827 - Phone
- (712) 256-4420
- Fax
- (712) 256-4423
- NPI assigned
- Oct 21, 2006
- 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 |
|---|---|---|---|---|
| Social Worker | 104100000X | LCSW 1749 | SD | Primary |
Addresses
Primary practice location
500 Willow Ave
Suite 305
Council Bluffs, IA 51503-0827
Mailing address
500 Willow Ave
Suite 305
Council Bluffs, IA 51503-0827
Phone (712) 256-4420
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6570882 | Medicaid | SD |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LCSW 1749 | SD | MD | Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lutheran Social Services of South Dakota Inc | Past | Accepting new patients |
Interoperability endpoints
- https://api.qualifacts.org/api/fhir/lsssd/r4/
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.
-
- Voluntary or Charitable Agency
- Sioux Falls, SD
- NPI 1194885723
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161388800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1410134400000",
"number": "1962585489",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "500 WILLOW AVE",
"address_2": "SUITE 305",
"city": "COUNCIL BLUFFS",
"state": "IA",
"postal_code": "515030827",
"telephone_number": "712-256-4420",
"fax_number": "712-256-4423"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "500 WILLOW AVE",
"address_2": "SUITE 305",
"city": "COUNCIL BLUFFS",
"state": "IA",
"postal_code": "515030827",
"telephone_number": "712-256-4420",
"fax_number": "712-256-4423"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRAZIL",
"first_name": "COLLEEN",
"middle_name": "M",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-21",
"last_updated": "2014-09-08",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "SD",
"license": "LCSW 1749",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "6570882",
"state": "SD"
}
],
"endpoints": [],
"other_names": []
}Other providers in Council Bluffs, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.