Provider Demographics
NPI:1760545180
Name:CHASE, ADAM C (LICSW)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:C
Last Name:CHASE
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1915 LYNDALE AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55403-3380
Mailing Address - Country:US
Mailing Address - Phone:800-336-5973
Mailing Address - Fax:612-234-4689
Practice Address - Street 1:1915 LYNDALE AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55403-3380
Practice Address - Country:US
Practice Address - Phone:800-336-5973
Practice Address - Fax:612-234-4689
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN162301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN617K3CHOtherBCBS, BURNSVILLE COUSELIN
MN1046764OtherPREF. 1, BURNSVILLE COUNS
MN924SOCHOtherBCBS, PRIVATE, NON-PARTIC
MN62-67037OtherMEDICA, BURSNVILLE COUNSE