Stephanie Si-Yu Shao, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

127453 Issued in CA

Practice address

169 Saxony Rd Ste 111
Encinitas, CA 92024-6779

Phone

(760) 278-8934

NPI assigned

Jul 5, 2021

Reactivated

Oct 17, 2023

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Sep 6, 2025 through Sep 6, 2027

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Womens Center

  • Clinical Social Worker
  • Vienna, VA
  • NPI 1164527859
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1625443200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733184000000",
    "number": "1003487778",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "169 SAXONY RD STE 111",
            "city": "ENCINITAS",
            "state": "CA",
            "postal_code": "920246779",
            "telephone_number": "760-278-8934"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "169 SAXONY RD STE 111",
            "city": "ENCINITAS",
            "state": "CA",
            "postal_code": "920246779",
            "telephone_number": "760-278-8934"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAO",
        "first_name": "STEPHANIE",
        "middle_name": "SI-YU",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-07-05",
        "last_updated": "2024-12-03",
        "certification_date": "2024-12-03",
        "deactivation_date": "2023-07-11",
        "reactivation_date": "2023-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "DC",
            "license": "LC200003288",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "127453",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "SimplePractice.com",
            "affiliation": "Y",
            "affiliationName": "Nourished Psychotherapy Group",
            "address_1": "169 Saxony Rd Ste 111",
            "city": "Encinitas",
            "state": "CA",
            "country_code": "US",
            "postal_code": "920246779",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Gautam J Shah, M. D.
• Niyati Bharat Shah, M.D.
• Puja Shah, D.M.D.
• Sagar Kamlesh Shah, MD
• Ali Shahrokh, DMD
• John Alan Sharkey, MMS, PA-C
• Kelly Shaughnessy, RD BS
• Erika Katherine Shaw, L.AC, DACM, CMT
• Kevin Daniel Shaw, M.D
• Paula Hollis Shaw, CADC L

• Clinical Social Worker in Encinitas, CA
• Providers in Encinitas, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.