Mary Juanita Shakes, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

0113C Issued in MS

Practice address

205 Herbert Street
Demopolis, AL 36732

Phone

(334) 341-7400

Fax

(601) 485-5215

NPI assigned

Nov 11, 2006

Last updated

Aug 24, 2011By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 4

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• New Beginnings

  • Counselor
  • Meridian, MS
  • NPI 1720173974
  NPD (past)

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

{
    "created_epoch": "1163203200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1314144000000",
    "number": "1083785182",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 1127",
            "city": "DEMOPOLIS",
            "state": "AL",
            "postal_code": "36732",
            "telephone_number": "334-341-7400",
            "fax_number": "334-287-2331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 HERBERT STREET",
            "city": "DEMOPOLIS",
            "state": "AL",
            "postal_code": "36732",
            "telephone_number": "334-341-7400",
            "fax_number": "601-485-5215"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAKES",
        "first_name": "MARY",
        "middle_name": "JUANITA",
        "name_prefix": "Mrs.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-11-11",
        "last_updated": "2011-08-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "AL",
            "license": "0113C",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MS",
            "license": "C7264",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MS",
            "license": "0113C",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "P00408326",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• RTG Medical
• Rural Health Medical Program, Inc (Demopolis Health Center)
• Mohammed Salehuddin, MD
• Kayla J Scott, CRNP
• Selma Family Practice Optometry, Inc. (Eyemax Vision Center)
• Ellen Lewis Singleton, CRNP
• Southeast Cancer Network, Inc
• William Don Sprewell, PT
• Statewide Healthcare Services, Inc (Oxford Healthcare)
• Hannah Stewart, MS, ATC

• Clinical Social Worker in Demopolis, AL
• Providers in Demopolis, AL by specialty
• Clinical Social Worker in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2011; 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.