NPIMap

Organization Active NPI

Shiny Triangle LCSW PC

  • Clinical Social Worker
  • Cincinnati, OH
National Provider Identifier
1164175105
Registry record updated Jan 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
SHINY TRIANGLE LCSW PC
Practice address
1171 Towne St
Cincinnati, OH 45216-2227
Phone
(212) 734-6621
NPI assigned
Jan 31, 2022
Last updated
Jan 10, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 10, 2024

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

Authorized official

Name
Samuel WeiserNPI 1619421476
Title
Owner
Phone
(845) 425-0982

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Cognitive & Behavioral PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TB0200X
Clinical Child & Adolescent PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC2200X
Family PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TF0000X
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X Primary

Addresses

Primary practice location

1171 Towne St
Cincinnati, OH 45216-2227

Mailing address

254 Old Nyack Tpke
Spring Valley, NY 10977-5741

Other practice location 1

254 Old Nyack Tpke
Spring Valley, NY 10977-5741
Phone (845) 425-0982

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, MO, PA, OH, GA5 enrollments

Enrollment records 5

Enrollment IDStateProvider typePAC IDDetails
O20220414002466 NY Part B Supplier - Clinic/Group Practice 1254727480 Receives reassigned benefits from 4 practitioners
Practice locations: Spring Valley, NY
O20231113003021 MO Part B Supplier - Clinic/Group Practice 1254727480 Receives reassigned benefits from 2 practitioners
Practice locations: Valley Park, MO
O20231127001809 PA Part B Supplier - Clinic/Group Practice 1254727480 Receives reassigned benefits from 2 practitioners
Practice locations: Canonsburg, PA
O20231205003903 OH Part B Supplier - Clinic/Group Practice 1254727480 Receives reassigned benefits from 2 practitioners
Practice locations: Cincinnati, OH
O20240328000517 GA Part B Supplier - Clinic/Group Practice 1254727480 Receives reassigned benefits from 1 practitioner
Practice locations: Macon, GA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1643587200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704844800000",
    "number": "1164175105",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "254 OLD NYACK TPKE",
            "city": "SPRING VALLEY",
            "state": "NY",
            "postal_code": "109775741"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1171 TOWNE ST",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452162227",
            "telephone_number": "212-734-6621"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "254 Old Nyack Tpke",
            "address_purpose": "LOCATION",
            "city": "Spring Valley",
            "state": "NY",
            "postal_code": "109775741",
            "country_code": "US",
            "telephone_number": "845-425-0982",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SHINY TRIANGLE LCSW PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-31",
        "last_updated": "2024-01-10",
        "certification_date": "2024-01-10",
        "status": "A",
        "authorized_official_last_name": "WEISER",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "845-425-0982"
    },
    "taxonomies": [
        {
            "code": "103TB0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Family",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cincinnati, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.