Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Mary Rose Nettleton, LICSW

Individual provider Social Worker · NPI 1073611729

Mary Rose Nettleton, LICSW is a Social Worker in Fridley, Minnesota. Licensed in Minnesota. Registered with an NPI since 2006.

Licensed in
MN
In the registry since
2006
What do these letters mean?
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

7362 University Ave NE Ste 209
Fridley, MN 55432-3142
Phone: (612) 825-4407
Fax: (612) 825-0768
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Social Worker (primary) Taxonomy 104100000X · Licence 10269 (MN)

Record details

NPI number1073611729
Entity typeIndividual (Type 1)
GenderFemale
Credentials LICSW
Sole proprietorNo
NPI enumeratedSeptember 20, 2006
Last updated in NPPESJuly 8, 2007

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