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General NPI Number Information
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NPI Number | 1265539308
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Entity Type | Individual
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Provider Name | SHELLEY SEARS BERVEN MSW
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Gender | Female
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 01/21/2019
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Provider Practice Location Address
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Address Line | 790 CLEVELAND AVE S STE 207
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City | SAINT PAUL
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State | MN
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Zip | 55116-3866
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Country | US
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Telephone | 651-224-3035
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Fax | 651-690-0968
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Provider Business Mailing Address
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Address Line | 2273 GORDON AVE
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City | SAINT PAUL
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State | MN
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Zip | 55108-1904
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Country | US
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Telephone | 651-293-3923
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Fax | 651-642-5909
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 06845
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License Number State | MN
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