Individual provider Active NPI

Shawn Ennuson, LCSW

  • Clinical Social Worker
  • Rochester, NY
National Provider Identifier
1073004198
Registry record updated Jun 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
092899 Issued in NY
Practice address
2300 East Ave
Rochester, NY 14610-2564
Phone
(585) 766-8107
Fax
(585) 397-1916
NPI assigned
May 24, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 3, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 092899 NY Primary

Addresses

Primary practice location

2300 East Ave
Rochester, NY 14610-2564

Mailing address

2300 East Ave
Rochester, NY 14610-2564
Phone (585) 766-8107

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220323000571 NY Practitioner - Clinical Social Worker 6800281148 Practice locations: Rochester, NY

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
092899NYMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Shawn Ennuson, LCSW, P.C. CurrentSince Dec 1, 2022 Accepting new patients
Villa of Hope PastSince May 10, 2016 Accepting new patients

Locations

1100 University Ave
Ste 209
Rochester, NY 14607
Phone (585) 877-2437

2300 East Ave
Rochester, NY 14610
Phone (585) 248-6203

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1527120000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1748908800000",
    "number": "1073004198",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2300 EAST AVE",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146102564",
            "telephone_number": "585-766-8107",
            "fax_number": "585-397-1916"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2300 EAST AVE",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146102564",
            "telephone_number": "585-766-8107",
            "fax_number": "585-397-1916"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ENNUSON",
        "first_name": "SHAWN",
        "name_prefix": "Mrs.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-05-24",
        "last_updated": "2025-06-03",
        "certification_date": "2025-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "092899",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rochester, NY

Sources for this page

Verify at the official NPI Registry.