Maureen Ellis, LICSW, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

26144 Issued in CA

Practice address

4151 Thomas Ave N
Minneapolis, MN 55412

Phone

(818) 209-9885

NPI assigned

Nov 16, 2012

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

Medicare fee-for-service enrollment

Enrolled in MN

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, 2004

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Heal With Me Psychotherapy LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Minneapolis, MN
  • NPI 1972485878
  Medicare reassignment NPD Authorized official
• Northside Center for Emotional Wellness LLC

  • Psychologist
  • Minneapolis, MN
  • NPI 1518332709
  NPD (past)
• Northside Center for Emotional Wellness LLC

  • Clinical Child & Adolescent Psychologist
  • Minneapolis, MN
  • NPI 1629522081
  NPD (past)

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

{
    "created_epoch": "1353024000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1528416000000",
    "number": "1962746859",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4151 THOMAS AVE N",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554121517",
            "telephone_number": "612-310-8683",
            "fax_number": "651-925-0441"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4151 THOMAS AVE N",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "55412",
            "telephone_number": "818-209-9885"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "MAUREEN",
        "name_prefix": "Ms.",
        "credential": "LICSW, LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-11-16",
        "last_updated": "2018-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "26144",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sean Patrick Elliott, MD
• Susan Elliott
• Brenna Ellis, OTD
• Lindsey Ellis
• Lisa Marie Ellis, MA, LICSW, CCM
• Shane Thomas Ellis, M.D.
• Tasha J Ellis, PSY.D.
• Tyler Ellis, MD
• Tayt Ellison, M.D.
• Patricia Diane Ells, M.A., L.P.

• 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 Jun 8, 2018; 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.