Individual provider Active NPI

Margaret Victoria Shepard-Moore

  • Clinical Social Worker
  • San Luis Obispo, CA
National Provider Identifier
1053894279
Registry record updated Feb 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
119881 Issued in CA
Practice address
784 High St
San Luis Obispo, CA 93401-5243
Phone
(805) 540-6500
Fax
(805) 540-6501
NPI assigned
Sep 13, 2018
Last updated
Feb 10, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 10, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X
Clinical Social Worker 1041C0700X 119881 CA Primary

Addresses

Primary practice location

784 High St
San Luis Obispo, CA 93401-5243

Mailing address

PO Box 15408
San Luis Obispo, CA 93406-5408
Phone (805) 540-6500

Other practice location 1

1122 California Blvd
San Luis Obispo, CA 93401-2910
Phone (805) 459-9955

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
119881CAMDMarriage & Family Therapist

NPI Registry JSON

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

{
    "created_epoch": "1536796800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707523200000",
    "number": "1053894279",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 15408",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934065408",
            "telephone_number": "805-540-6500",
            "fax_number": "805-540-6501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "784 HIGH ST",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934015243",
            "telephone_number": "805-540-6500",
            "fax_number": "805-540-6501"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1122 California Blvd",
            "address_purpose": "LOCATION",
            "city": "San Luis Obispo",
            "state": "CA",
            "postal_code": "934012910",
            "country_code": "US",
            "telephone_number": "805-459-9955",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHEPARD-MOORE",
        "first_name": "MARGARET",
        "middle_name": "VICTORIA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-09-13",
        "last_updated": "2024-02-10",
        "certification_date": "2024-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "119881",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Luis Obispo, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.