Healthcare Provider Details

I. General information

NPI: 1831421205
Provider Name (Legal Business Name): MONICA OBERG MSW, LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2010
Last Update Date: 06/24/2021
Certification Date: 06/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 CLEVELAND AVE N
ROSEVILLE MN
55113-1126
US

IV. Provider business mailing address

1097 MONTANA AVE W
SAINT PAUL MN
55117-3324
US

V. Phone/Fax

Practice location:
  • Phone: 651-642-1825
  • Fax:
Mailing address:
  • Phone: 651-468-7341
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number14062
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: