Active NPI
Dominique Shade, LMSW
- Social Worker
- Albany, NY
National Provider Identifier
1336676048
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 099317
- Practice address
- 75 New Scotland Ave
Albany, NY 12208-3409 - Phone
- (518) 549-6500
- NPI assigned
- May 12, 2017
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 099317 | NY | Primary |
Addresses
Primary practice location
75 New Scotland Ave
Albany, NY 12208-3409
Mailing address
44 Voyage Dr
Glenmont, NY 12077-3514
Phone (518) 545-0195
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 099317 | NY | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1494547200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1494547200000",
"number": "1336676048",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "44 VOYAGE DR",
"city": "GLENMONT",
"state": "NY",
"postal_code": "120773514",
"telephone_number": "518-545-0195"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "75 NEW SCOTLAND AVE",
"city": "ALBANY",
"state": "NY",
"postal_code": "122083409",
"telephone_number": "518-549-6500"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHADE",
"first_name": "DOMINIQUE",
"credential": "LMSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-05-12",
"last_updated": "2017-05-12",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "NY",
"license": "099317",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Albany, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.