Shani Cohen Missner, MD, PHD, LCSW-C, CLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

27849 Issued in MD

Practice address

10810 Darnestown Rd Ste 103
Gaithersburg, MD 20878-2604

Phone

(240) 630-4497

Fax

(301) 279-2232

NPI assigned

Apr 10, 2018

Reactivated

Jun 13, 2024

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine, Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1523318400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719792000000",
    "number": "1316444052",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10810 DARNESTOWN RD STE 103",
            "city": "GAITHERSBURG",
            "state": "MD",
            "postal_code": "208782604",
            "telephone_number": "240-630-4497",
            "fax_number": "301-279-2232"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10810 DARNESTOWN RD STE 103",
            "city": "GAITHERSBURG",
            "state": "MD",
            "postal_code": "208782604",
            "telephone_number": "240-630-4497",
            "fax_number": "301-279-2232"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MISSNER",
        "first_name": "SHANI",
        "middle_name": "COHEN",
        "name_prefix": "Dr.",
        "credential": "MD, PHD, LCSW-C, CLC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-04-10",
        "last_updated": "2024-07-01",
        "certification_date": "2024-07-01",
        "deactivation_date": "2018-08-21",
        "reactivation_date": "2024-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MD",
            "license": "27849",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in Gaithersburg, MD
• Providers in Gaithersburg, MD by specialty
• Clinical Social Worker in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.