Shannon Christine Secrist, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LCS23562 Issued in CA

Practice address

529 Main St Ste 100
Charlestown, MA 02129-1119

Phone

(617) 756-2151

NPI assigned

Sep 20, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 1995

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Moona Medical Group of California PCGroup PAC ID 2365955630, 25 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Moona Medical Group of California PC

  dba Moona Health

  • Mental Health Counselor
  • San Francisco, CA
  • NPI 1023824836
  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722816000000",
    "number": "1275631723",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "406 TECHNOLOGY CENTER DR UNIT 4409",
            "city": "STOUGHTON",
            "state": "MA",
            "postal_code": "020724738",
            "telephone_number": "530-520-9319"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "529 MAIN ST STE 100",
            "city": "CHARLESTOWN",
            "state": "MA",
            "postal_code": "021291119",
            "telephone_number": "617-756-2151"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1965 Live Oak Blvd",
            "address_2": "Suite A",
            "address_purpose": "LOCATION",
            "city": "Yuba City",
            "state": "CA",
            "postal_code": "959918850",
            "country_code": "US",
            "telephone_number": "530-822-7200 x2256",
            "fax_number": "530-822-7518",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SECRIST",
        "first_name": "SHANNON",
        "middle_name": "CHRISTINE",
        "name_prefix": "Ms.",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-20",
        "last_updated": "2024-08-05",
        "certification_date": "2021-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MA",
            "license": "LICSW126386",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "LCS23562",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Meryl Heller Schram, M.S., CCC-SLP
• Neil I Schram, OD
• Katherine Schramm, DPT
• Carl R E Schwartz, MD
• Sophia Scolnik-Brower
• Rorn Seng-Yem, NP
• Adrienne Senneville, PT
• Serene Haven of Massachusetts LLC
• Margaret Seymour
• Dennis C Sgroi, MD

• Clinical Social Worker in Charlestown, MA
• Providers in Charlestown, MA by specialty
• Clinical Social Worker in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.