MEDICARE: MARY MONIQUE SEBRING LICSW

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	12895	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	42G17AV	OTHER	MN	BCBS MN
2	990991042538	OTHER	MN	BHP PREFERRED 1
3	56308-A002	OTHER	MN	TRI WEST
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	62-76940	OTHER	MN	MEDICA UBH
6	HP39762	OTHER	MN	HEALTH PARTNERS
7	113219	OTHER	MN	U CARE
8	31002005	OTHER	MN	PRIME WEST

General Provider Information

NPI Number	:	1306935812
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY MONIQUE SEBRING LICSW

Provider Business Mailing Address
First Line	:	1306 MARSHALL ST
Second Line	:
City	:	SAINT PETER
State	:	MN
Zip	:	56082-4500
Country	:	US
Telephone Number	:	507-931-8040
Fax Number	:	507-931-8060

Provider Business Practice Location Address
First Line	:	1306 MARSHALL ST
Second Line	:
City	:	SAINT PETER
State	:	MN
Zip	:	56082-4500
Country	:	US
Telephone Number	:	507-931-8040
Fax Number	:	507-931-8060

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

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	09/03/2021

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Directions to “ MARY MONIQUE SEBRING LICSW” Practice Location

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