Daeseong Shin, LCPC

Primary specialty

CounselorTaxonomy code 101Y00000X

License

LC14961 Issued in MD

Practice address

429 Ingram CT
Glen Burnie, MD 21061-6125

Phone

(443) 585-8167

NPI assigned

Dec 30, 2024

Last updated

Jan 2, 2025By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MD

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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

• Institute for Healing, LLC

  • Clinical Psychologist
  • Owings Mills, MD
  • NPI 1629438122
  Medicare reassignment NPD

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

{
    "created_epoch": "1735516800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1735776000000",
    "number": "1073322558",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "429 INGRAM CT",
            "city": "GLEN BURNIE",
            "state": "MD",
            "postal_code": "210616125",
            "telephone_number": "443-585-8167"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "429 INGRAM CT",
            "city": "GLEN BURNIE",
            "state": "MD",
            "postal_code": "210616125",
            "telephone_number": "443-585-8167"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9419 Common Brook Rd Ste 208",
            "address_purpose": "LOCATION",
            "city": "Owings Mills",
            "state": "MD",
            "postal_code": "211177570",
            "country_code": "US",
            "telephone_number": "443-585-8167 x742",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHIN",
        "first_name": "DAESEONG",
        "credential": "LCPC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-12-30",
        "last_updated": "2025-01-02",
        "certification_date": "2025-01-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "MD",
            "license": "LC14961",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tova Sherry, NURSE PRACTITIONER
• Jennifer Sherwood, NP
• Nikhil Sheth, M.D.
• Micheline Christina Shields, LCPC
• Henry Edison Shih
• Pomi Shin
• Heather L Shinnamon, LCSW-C
• Drey Shipley, BCBA
• Shiva Priya LLC (ComForCare Home Care Howard County & Northern Anne Arundel)
• Morris M Shochet, MD

• Counselor in Glen Burnie, MD
• Providers in Glen Burnie, MD by specialty
• Counselor in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.