Shelley Beth Kingsbury, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

010666 Issued in CT

Practice address

1101 Noank Ledyard Rd # 12
Mystic, CT 06355-1361

Phone

(860) 861-8393

NPI assigned

Nov 20, 2019

Sex

Female

Sole proprietor

Yes

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 CT

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

Specialty

Clinical Social Worker

Education

Fordham University School of Medicine, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

State of ConnecticutGroup PAC ID 8022915677, shared by 11 NPIs, 267 clinicians

Windham Community Memorial Hospital IncGroup PAC ID 2961309059, 67 clinicians

Practice addresses (Care Compare)

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 and National Provider Directory roles.

• Windham Community Memorial Hospital, Inc.

  • General Acute Care Hospital
  • Willimantic, CT
  • NPI 1023191467
  Medicare reassignment Care Compare group NPD
• State of Connecticut

  dba River Valley Services

  • Adult Mental Health Clinic/Center
  • Middletown, CT
  • NPI 1427074426
  Medicare reassignment NPD
• State of Connecticut

  dba Southeastern Mental Health Authority

  • Adult Mental Health Clinic/Center
  • Norwich, CT
  • NPI 1902831548
  Medicare reassignment NPD
• The William W Backus Hospital

  • General Acute Care Hospital
  • Norwich, CT
  • NPI 1467517235
  Medicare reassignment NPD
• State of Connecticut

  dba Department of Veterans' Affairs, Veterans Home

  • Skilled Nursing Facility
  • Rocky Hill, CT
  • NPI 1205951662
  NPD
• William W Backus Hospital

  • Psychiatric Hospital Unit
  • Norwich, CT
  • NPI 1730243536
  NPD

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

{
    "created_epoch": "1574208000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629936000000",
    "number": "1104462654",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22A AUTUMN VIEW DR",
            "city": "LISBON",
            "state": "CT",
            "postal_code": "063512901",
            "telephone_number": "860-861-8393"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 NOANK LEDYARD RD # 12",
            "city": "MYSTIC",
            "state": "CT",
            "postal_code": "063551361",
            "telephone_number": "860-861-8393"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KINGSBURY",
        "first_name": "SHELLEY",
        "middle_name": "BETH",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-11-20",
        "last_updated": "2021-08-26",
        "certification_date": "2021-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CT",
            "license": "010666",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Paul C Kelleher, MD
• Tara Kelly
• Christine Kendall, MA
• Keys2Memory, LLC
• Eldon Richard Kilpatrick, PTA
• Gayle Kissinger
• Renee S Kohanski, M.D.
• Miranda Krause Cahill, LCSW
• Kellie Ann Kulick, LPTA
• Ann Marie Kupis, PT

• Clinical Social Worker in Mystic, CT
• Providers in Mystic, CT by specialty
• Clinical Social Worker in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2021; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.