Active NPI
Janis A Shannon, LCSW
- Clinical Social Worker
- Stuart, FL
National Provider Identifier
1164553194
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- SW0084
- Practice address
- 2440 SE Federal Hwy
#103
Stuart, FL 34994-4531 - Phone
- (772) 882-8836
- NPI assigned
- Mar 9, 2007
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 074605-1 | NY | |
| Clinical Social Worker | 1041C0700X | SW0084 | FL | Primary |
Addresses
Primary practice location
2440 SE Federal Hwy
#103
Stuart, FL 34994-4531
Mailing address
2440 SE Federal Hwy
#103
Stuart, FL 34994-4531
Phone (772) 882-8836
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| Z02HZ | Other | FL | BCBS PROVIDER NUMBER |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SW0084 | FL | MD | Clinical Social Worker |
| 074605-1 | NY | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173398400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1316044800000",
"number": "1164553194",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2440 SE FEDERAL HWY",
"address_2": "#103",
"city": "STUART",
"state": "FL",
"postal_code": "349944531",
"telephone_number": "772-882-8836"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2440 SE FEDERAL HWY",
"address_2": "#103",
"city": "STUART",
"state": "FL",
"postal_code": "349944531",
"telephone_number": "772-882-8836"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHANNON",
"first_name": "JANIS",
"middle_name": "A",
"name_prefix": "Ms.",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-03-09",
"last_updated": "2011-09-15",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NY",
"license": "074605-1",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "FL",
"license": "SW0084",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS PROVIDER NUMBER",
"identifier": "Z02HZ",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Stuart, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 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.