Active NPI
Susan Shaw, MSW, LICSW, LADC-1
- Clinical Social Worker
- Arlington, MA
National Provider Identifier
1023160538
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 1032175
- Practice address
- 299 Broadway
Arlington, MA 02474 - Phone
- (617) 224-3107
- Fax
- (617) 623-3653
- NPI assigned
- Jan 17, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 1626 | MA | |
| Clinical Social Worker | 1041C0700X | 1032175 | MA | Primary |
Addresses
Primary practice location
299 Broadway
Arlington, MA 02474
Mailing address
PO Box 440189
Somerville, MA 02144-0002
Phone (617) 224-3107
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Previously, effective Jul 31, 2024 through Jul 31, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1032175 | MA | MD | Clinical Social Worker |
| 1626 | MA | MD | Orthopedic Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168992000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1285027200000",
"number": "1023160538",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 440189",
"city": "SOMERVILLE",
"state": "MA",
"postal_code": "021440002",
"telephone_number": "617-224-3107"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "299 BROADWAY",
"city": "ARLINGTON",
"state": "MA",
"postal_code": "02474",
"telephone_number": "617-224-3107",
"fax_number": "617-623-3653"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHAW",
"first_name": "SUSAN",
"credential": "MSW, LICSW, LADC-1",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-01-17",
"last_updated": "2010-09-21",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "MA",
"license": "1626",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MA",
"license": "1032175",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Arlington, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2010; 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.