Active NPI
Shakira M Puello, LICSW
- Clinical Social Worker
- Somerville, MA
National Provider Identifier
1144508060
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 121026
- Practice address
- 240 Elm Street
2ND & 3Rd FL
Somerville, MA 02144 - Phone
- (978) 238-4911
- NPI assigned
- Jul 26, 2011
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 121026 | MA | Primary |
Addresses
Primary practice location
240 Elm Street
2ND & 3Rd FL
Somerville, MA 02144
Mailing address
240 Elm Street
2ND & 3Rd FL
Somerville, MA 02144
Phone (978) 238-4911
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 129577579 | Other | MA | CASE MANAGER |
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
| License | State | Type | Specialty |
|---|---|---|---|
| 121026 | MA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1311638400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1607385600000",
"number": "1144508060",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "240 ELM STREET",
"address_2": "2ND & 3RD FL",
"city": "SOMERVILLE",
"state": "MA",
"postal_code": "02144",
"telephone_number": "978-238-4911"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "240 ELM STREET",
"address_2": "2ND & 3RD FL",
"city": "SOMERVILLE",
"state": "MA",
"postal_code": "02144",
"telephone_number": "978-238-4911"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PUELLO",
"first_name": "SHAKIRA",
"middle_name": "M",
"credential": "LICSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-07-26",
"last_updated": "2020-12-08",
"certification_date": "2020-12-08",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MA",
"license": "121026",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CASE MANAGER",
"identifier": "129577579",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Somerville, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.