Active NPI
Shawn Channell, PH.D.
- Forensic Psychologist
- Fitchburg, MA
National Provider Identifier
1184112948
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Forensic Psychologist
- License
- 9403
- Practice address
- 76 Summer St Ste 115
Fitchburg, MA 01420-5705 - Phone
- (978) 257-4958
- NPI assigned
- Apr 27, 2018
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 18566 | CA | |
| Forensic Psychologist | 103TF0200X | 9403 | MA | Primary |
Addresses
Primary practice location
76 Summer St Ste 115
Fitchburg, MA 01420-5705
Mailing address
144 Main St
Westminster, MA 01473-1542
Phone (978) 257-4958
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
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 18566 | CA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1524787200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1524787200000",
"number": "1184112948",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "144 MAIN ST",
"city": "WESTMINSTER",
"state": "MA",
"postal_code": "014731542",
"telephone_number": "978-257-4958"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "76 SUMMER ST STE 115",
"city": "FITCHBURG",
"state": "MA",
"postal_code": "014205705",
"telephone_number": "978-257-4958"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHANNELL",
"first_name": "SHAWN",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2018-04-27",
"last_updated": "2018-04-27",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "18566",
"primary": false
},
{
"code": "103TF0200X",
"taxonomy_group": "",
"desc": "Psychologist, Forensic",
"state": "MA",
"license": "9403",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fitchburg, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.