Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Lisa Marie Ellis, MA, LICSW, CCM

Individual provider Clinical Social Worker · NPI 1891593133

Lisa Marie Ellis, MA, LICSW, CCM is a Clinical Social Worker in Minneapolis, Minnesota. Qualified in 1985, 41 years ago. Practices with Associated Clinic of Psychology Inc, a 137-clinician group and accepts Medicare assignment. Licensed in Minnesota.

Years since qualifying
41
Licensed in
MN
In the registry since
2025
What do these letters mean?
MA — Master of Arts
A graduate arts degree.
LICSW — Licensed Independent Clinical Social Worker
The title some states use for an independently practising clinical social worker.

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Practice location Address checks out

4027 County Road 25
Minneapolis, MN 55416-2629
Phone: (612) 925-6033
Fax: (612) 925-8496
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Social Worker (primary) Taxonomy 1041C0700X · Licence 3392 (MN)

Record details

NPI number1891593133
Entity typeIndividual (Type 1)
GenderFemale
Credentials MA , LICSW , CCM
Sole proprietorNo
NPI enumeratedMarch 4, 2025
Last updated in NPPESMarch 4, 2025
Certification dateMarch 4, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCLINICAL SOCIAL WORKER
Medical schoolOTHER
Graduated 1985 (41 years in practice)
Group practice Associated Clinic Of Psychology Inc — 137 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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