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Minnesota Uniform Credentialing Application Initial Physician/Dentist/Allied Health Professional Applicant Name (as shown on your state license): LastFirstMiddleSuffixTitleCREDENTIALING CONTACT INFORMATION
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A clinical social worker provider is a licensed professional who offers mental health services, including therapy and counseling, to individuals, families, and groups, focusing on improving well-being and social functioning.
Licensed clinical social workers who provide mental health services and wish to bill insurance companies or receive reimbursement from programs like Medicare or Medicaid are required to file as clinical social worker providers.
To fill out a clinical social worker provider form, you need to provide personal information, professional licensing details, and any required documentation that proves your qualifications and practice.
The purpose of the clinical social worker provider designation is to ensure that qualified professionals can offer mental health services and receive appropriate compensation for their work.
Information that must be reported includes the clinical social worker's name, contact information, license number, service specialties, and any accreditation or certifications.
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