Active NPI
Michael J Shanley, MSW
- Clinical Social Worker
- Green Bay, WI
National Provider Identifier
1427158559
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 1401
- Practice address
- 3150 Gershwin Drive
Green Bay, WI 54311-5859 - Phone
- (920) 391-6940
- Fax
- (920) 391-4811
- NPI assigned
- Sep 25, 2006
- Sex
- Male
- 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 | 1401 | WI | Primary |
Addresses
Primary practice location
3150 Gershwin Drive
Green Bay, WI 54311-5859
Mailing address
3150 Gershwin Drive
Green Bay, WI 54311-5859
Phone (920) 391-6940
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 39619000 | Medicaid | WI |
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 |
|---|---|---|---|
| 1401 | WI | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159142400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1257984000000",
"number": "1427158559",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3150 GERSHWIN DRIVE",
"city": "GREEN BAY",
"state": "WI",
"postal_code": "543115859",
"telephone_number": "920-391-6940",
"fax_number": "920-391-4811"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3150 GERSHWIN DRIVE",
"city": "GREEN BAY",
"state": "WI",
"postal_code": "543115859",
"telephone_number": "920-391-6940",
"fax_number": "920-391-4811"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHANLEY",
"first_name": "MICHAEL",
"middle_name": "J",
"credential": "MSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-25",
"last_updated": "2009-11-12",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "WI",
"license": "1401",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "39619000",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Green Bay, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.