Shaun Edward Willis, LMSW

Primary specialty

Social WorkerTaxonomy code 104100000X

License

074650 Issued in NY

Practice address

998 Crooked Hill Rd
Pilgrim Psych Center BLDG #5
Brentwood, NY 11717-1019

Phone

(631) 306-5869

Fax

(631) 306-5886

NPI assigned

Feb 18, 2010

Sex

Male

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Alanna a. Quinn

  • Social Worker
  • East Hampton, NY
  • NPI 1609398569
  NPD (past)
• Phoenix Houses of Long Island, Inc.

  • Substance Abuse Rehabilitation Facility
  • Brentwood, NY
  • NPI 1174691281
  NPD (past)

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

{
    "created_epoch": "1266451200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1266451200000",
    "number": "1457673451",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "998 CROOKED HILL RD",
            "address_2": "PILGRIM PSYCH CENTER BLDG #5",
            "city": "BRENTWOOD",
            "state": "NY",
            "postal_code": "117171019",
            "telephone_number": "631-306-5869",
            "fax_number": "631-306-5886"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "998 CROOKED HILL RD",
            "address_2": "PILGRIM PSYCH CENTER BLDG #5",
            "city": "BRENTWOOD",
            "state": "NY",
            "postal_code": "117171019",
            "telephone_number": "631-306-5869",
            "fax_number": "631-306-5886"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIS",
        "first_name": "SHAUN",
        "middle_name": "EDWARD",
        "name_prefix": "Mr.",
        "credential": "LMSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-02-18",
        "last_updated": "2010-02-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NY",
            "license": "074650",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Laurinda Westhoff-Grant, SLP M.A.,CCC
• Ashley White
• Erika Alexandria White
• Dionne Williams
• Sallie Ann Williamson, LMSW
• Akisha Wilson, NP
• Peter Winston
• Bianca M. Wisdom
• William James Wisniewski, L.C.S.W
• Joseph Xerri, M.D.

• Social Worker in Brentwood, NY
• Providers in Brentwood, NY by specialty
• Social Worker in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2010; 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.