Individual provider Active NPI

Shawn Douglas Wood, LCSW, CYC-P

  • Clinical Social Worker
  • Sacramento, CA
National Provider Identifier
1104547421
Registry record updated Oct 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
108269 Issued in TX
Practice address
1401 21St St Ste R
Sacramento, CA 95811-5226
Phone
(737) 290-0897
NPI assigned
Sep 6, 2022
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 24, 2025

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 6577 ND
Clinical Social Worker 1041C0700X 108269 TX Primary
Clinical Social Worker 1041C0700X 127932 MA
Clinical Social Worker 1041C0700X 119727 CA
Clinical Social Worker 1041C0700X 089.0135350 VT

Addresses

Primary practice location

1401 21St St Ste R
Sacramento, CA 95811-5226

Mailing address

1401 21St St Ste R
Sacramento, CA 95811-5226
Phone (737) 290-0897

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)
Not enrolled

State licenses

LicenseStateTypeSpecialty
119727CAMDClinical Social Worker
127932MAMDClinical Social Worker
6577NDMDClinical Social Worker
108269TXMDClinical Social Worker
089.0135350VTMDClinical Social Worker

NPI Registry JSON

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

{
    "created_epoch": "1662422400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1761264000000",
    "number": "1104547421",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1401 21ST ST STE R",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958115226",
            "telephone_number": "737-290-0897"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 21ST ST STE R",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958115226",
            "telephone_number": "737-290-0897"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOOD",
        "first_name": "SHAWN",
        "middle_name": "DOUGLAS",
        "credential": "LCSW, CYC-P",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-09-06",
        "last_updated": "2025-10-24",
        "certification_date": "2025-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "ND",
            "license": "6577",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "TX",
            "license": "108269",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MA",
            "license": "127932",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "119727",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "VT",
            "license": "089.0135350",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sacramento, CA

Sources for this page

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