Active NPI
Shane William Macdonald, LCSW
- Social Worker
- Medford, MA
National Provider Identifier
1174124226
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 223903
- Practice address
- 20 Stearns Ave
Medford, MA 02155-5620 - Phone
- (860) 964-9398
- NPI assigned
- Nov 5, 2020
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Social Worker | 104100000X | 223903 | MA | Primary |
Addresses
Primary practice location
20 Stearns Ave
Medford, MA 02155-5620
Mailing address
20 Stearns Ave
Medford, MA 02155-5620
Phone (860) 964-9398
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 |
|---|---|---|---|
| 223903 | MA | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1604534400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1604534400000",
"number": "1174124226",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "20 STEARNS AVE",
"city": "MEDFORD",
"state": "MA",
"postal_code": "021555620",
"telephone_number": "860-964-9398"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "20 STEARNS AVE",
"city": "MEDFORD",
"state": "MA",
"postal_code": "021555620",
"telephone_number": "860-964-9398"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MACDONALD",
"first_name": "SHANE",
"middle_name": "WILLIAM",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-11-05",
"last_updated": "2020-11-05",
"certification_date": "2020-11-05",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "MA",
"license": "223903",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Medford, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 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.