Active NPI
Shelley Maureen Samuels
- Professional Counselor
- San Francisco, CA
National Provider Identifier
1194273821
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 1635
- Practice address
- 368 Fell St
San Francisco, CA 94102-5144 - Phone
- (415) 861-0828
- Fax
- (415) 861-0257
- NPI assigned
- Sep 11, 2016
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | PCCI 1635 | CA | |
| Professional Counselor | 101YP2500X | 1635 | CA | Primary |
Addresses
Primary practice location
368 Fell St
San Francisco, CA 94102-5144
Mailing address
368 Fell St
San Francisco, CA 94102-5144
Phone (415) 861-0828
Other practice location 1
2712 Telegraph Ave
Berkeley, CA 94705-1117
Phone (510) 548-8283 ext. 125
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 1, 2024 through Jan 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6947 | CA | MD | Massage Therapist |
| 1635 | CA | MD | Occupational Therapist |
| PCCI 1635 | CA | MD | Student in an Organized Health Care Education/Training Program |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1473552000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1522627200000",
"number": "1194273821",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "368 FELL ST",
"city": "SAN FRANCISCO",
"state": "CA",
"postal_code": "941025144",
"telephone_number": "415-861-0828",
"fax_number": "415-861-0257"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "368 FELL ST",
"city": "SAN FRANCISCO",
"state": "CA",
"postal_code": "941025144",
"telephone_number": "415-861-0828",
"fax_number": "415-861-0257"
}
],
"practiceLocations": [
{
"address_1": "2712 Telegraph Ave",
"address_purpose": "LOCATION",
"city": "Berkeley",
"state": "CA",
"postal_code": "947051117",
"country_code": "US",
"telephone_number": "510-548-8283 x125",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "SAMUELS",
"first_name": "SHELLEY",
"middle_name": "MAUREEN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-09-11",
"last_updated": "2018-04-02",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "CA",
"license": "PCCI 1635",
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "CA",
"license": "1635",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Francisco, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.