Active NPI
Shannon Ryan Legere, LCSW
- Clinical Social Worker
- Long Beach, CA
National Provider Identifier
1396861969
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 22103
- Practice address
- 456 Elm Ave
Long Beach, CA 90802 - Phone
- (562) 437-6717
- Fax
- (562) 437-5072
- NPI assigned
- Mar 22, 2007
- 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 |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 22103 | CA | Primary |
Addresses
Primary practice location
456 Elm Ave
Long Beach, CA 90802
Mailing address
2254 Gaviota Ave Unit 19
Signal Hill, CA 90755-3655
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 22103 | CA | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174521600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1535155200000",
"number": "1396861969",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2254 GAVIOTA AVE UNIT 19",
"city": "SIGNAL HILL",
"state": "CA",
"postal_code": "907553655"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "456 ELM AVE",
"city": "LONG BEACH",
"state": "CA",
"postal_code": "90802",
"telephone_number": "562-437-6717",
"fax_number": "562-437-5072"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEGERE",
"first_name": "SHANNON",
"middle_name": "RYAN",
"name_prefix": "Mrs.",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-03-22",
"last_updated": "2018-08-25",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "22103",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Long Beach, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.