Individual provider Active NPI

Sebastian J Shaw, LCSW

  • Social Worker
  • Montrose, NY
National Provider Identifier
1063660942
Registry record updated Apr 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
License
096068 Issued in NY
Practice address
2095 Albany Post Rd
Montrose, NY 10548
Phone
(914) 737-4400
NPI assigned
Sep 3, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 16, 2025

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
Social Worker 104100000X 096068 NY Primary

Addresses

Primary practice location

2095 Albany Post Rd
Montrose, NY 10548

Mailing address

2437 24TH St
Astoria, NY 11102-2827
Phone (510) 499-1487

Other practice location 1

2223 Martin Luther King Jr Way
Berkeley, CA 94704-1437
Phone (510) 499-1487

Other practice location 2

2437 24TH St
Astoria, NY 11102-2827
Phone (510) 499-1487

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)
Enrolled

State licenses

LicenseStateTypeSpecialty
096068NYMDSocial Worker

NPI Registry JSON

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

{
    "created_epoch": "1220400000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744761600000",
    "number": "1063660942",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2437 24TH ST",
            "city": "ASTORIA",
            "state": "NY",
            "postal_code": "111022827",
            "telephone_number": "510-499-1487"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2095 ALBANY POST RD",
            "city": "MONTROSE",
            "state": "NY",
            "postal_code": "10548",
            "telephone_number": "914-737-4400"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2223 Martin Luther King Jr Way",
            "address_purpose": "LOCATION",
            "city": "Berkeley",
            "state": "CA",
            "postal_code": "947041437",
            "country_code": "US",
            "telephone_number": "510-499-1487",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2437 24TH ST",
            "address_purpose": "LOCATION",
            "city": "ASTORIA",
            "state": "NY",
            "postal_code": "111022827",
            "country_code": "US",
            "telephone_number": "510-499-1487",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHAW",
        "first_name": "SEBASTIAN",
        "middle_name": "J",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-09-03",
        "last_updated": "2025-04-16",
        "certification_date": "2025-04-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NY",
            "license": "096068",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Montrose, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2025; 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.