MEDICARE: MS. SHELLEY SEARS BERVEN MSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	06845	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	172678	OTHER	MN	UCARE

General Provider Information

NPI Number	:	1265539308
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHELLEY SEARS BERVEN MSW

Provider Business Mailing Address
First Line	:	2273 GORDON AVE
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55108-1904
Country	:	US
Telephone Number	:	651-293-3923
Fax Number	:	651-642-5909

Provider Business Practice Location Address
First Line	:	790 CLEVELAND AVE S STE 207
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55116-3866
Country	:	US
Telephone Number	:	651-224-3035
Fax Number	:	651-690-0968

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	01/21/2019

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