Provider Demographics
NPI:1639235914
Name:ALBEE, MARK ANDREW NELSON (LICSW)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:ANDREW NELSON
Last Name:ALBEE
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:MARK
Other - Middle Name:ANDREW
Other - Last Name:ALBEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:4214 GRAND AVENUE
Mailing Address - Street 2:DULUTH CLINIC-WEST
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55807
Mailing Address - Country:US
Mailing Address - Phone:218-786-3500
Mailing Address - Fax:
Practice Address - Street 1:4214 GRAND AVENUE
Practice Address - Street 2:DULUTH CLINIC-WEST
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55807
Practice Address - Country:US
Practice Address - Phone:218-786-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2009-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN172321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN640171600Medicare ID - Type Unspecified