Active NPI
Shayna Kelleher, L.C.S.W.
- Clinical Social Worker
- San Diego, CA
National Provider Identifier
1205170040
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- LCS27620
- Practice address
- 5252 Balboa Ave
San Diego, CA 92117-6906 - Phone
- (858) 598-3818
- NPI assigned
- Nov 17, 2012
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | LCS27620 | CA | Primary |
Addresses
Primary practice location
5252 Balboa Ave
San Diego, CA 92117-6906
Mailing address
5252 Balboa Ave
Suite 803
San Diego, CA 92117-6906
Phone (858) 598-3818
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Nov 1, 2023 through Nov 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LCS27620 | CA | MD | Clinical Social Worker |
| 27620 | CA | MD | Radiology Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1353110400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1353110400000",
"number": "1205170040",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5252 BALBOA AVE",
"address_2": "SUITE 803",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921176906",
"telephone_number": "858-598-3818"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5252 BALBOA AVE",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921176906",
"telephone_number": "858-598-3818"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLEHER",
"first_name": "SHAYNA",
"name_prefix": "Ms.",
"credential": "L.C.S.W.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-11-17",
"last_updated": "2012-11-17",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "LCS27620",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2012; 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.