Rebecca L Shore, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

18343 Issued in MN

Practice address

2450 Riverside Ave Ste 2a-West
Minneapolis, MN 55454-1450

Phone

(612) 273-8700

Fax

(612) 273-8787

NPI assigned

Jun 18, 2011

Sex

Female

Sole proprietor

No

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

Enrolled in MN

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

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Children'S Clinic Network

  • Primary Care Clinic/Center
  • Hugo, MN
  • NPI 1447529235
  Medicare reassignment NPD
• Children'S Clinic Network

  • Primary Care Clinic/Center
  • Maple Grove, MN
  • NPI 1013278720
  NPD
• Children'S Clinic Network

  • Primary Care Clinic/Center
  • Brooklyn Park, MN
  • NPI 1588522668
  NPD
• Solutions Counseling Services, PLLC

  • Professional Counselor
  • Saint Michael, MN
  • NPI 1184871188

  Clinical

  NPD (past)

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

{
    "created_epoch": "1308355200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1510790400000",
    "number": "1447545322",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2450 RIVERSIDE AVE STE 2A-WEST",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554541450",
            "telephone_number": "612-273-8700",
            "fax_number": "612-273-8787"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2450 RIVERSIDE AVE STE 2A-WEST",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554541450",
            "telephone_number": "612-273-8700",
            "fax_number": "612-273-8787"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHORE",
        "first_name": "REBECCA",
        "middle_name": "L",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-06-18",
        "last_updated": "2017-11-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "18343",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Julie J Shomin, CRNA
• Brenda Aika Shoo, M.D.
• Zamzam Shoodeh
• Kelly M Shook, AU.D.
• Matthew Merritt Shore, MSW, LICSW
• Madhuri Kasat Shors, M.D., M.P.H.
• Brenda Short
• Susan Marie Shoultz, LCMT
• Shawn S Shrawny, M.D.
• Sabina Shrestha Dangol, CNP

• Clinical Social Worker in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Clinical Social Worker in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2017; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.