Individual provider Active NPI

Shane Thomas Whalen, LCSW

  • Clinical Social Worker
  • Schenectady, NY
National Provider Identifier
1457715310
Registry record updated Sep 13, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
089173 Issued in NY
Practice address
1044 State St
Schenectady, NY 12307-1508
Phone
(518) 370-1441
Fax
(518) 395-9431
NPI assigned
Apr 7, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 13, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 089173 NY Primary

Addresses

Primary practice location

1044 State St
Schenectady, NY 12307-1508

Mailing address

1044 State St
Schenectady, NY 12307-1508
Phone (518) 370-1441

Other identifiers 1

IdentifierTypeStateIssuer
02995513MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, MI2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20200923000579 NY Practitioner - Clinical Social Worker 8729407838 Reassigns benefits to 1 organization
I20230407001397 MI Practitioner - Clinical Social Worker 8729407838 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Ausable Valley Community Mental Health Services BoardGroup PAC ID 2961485610, 16 clinicians

Practice addresses (Care Compare)

511 Griffin Rd
West Branch, MI 48661-9251
Phone (989) 345-5571

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Ausable Valley Community Mental Health Services Board CurrentSince Apr 3, 2023 Accepting new patients
Schenectady Family Health Services, Inc. CurrentSince May 20, 2020 Accepting new patients
Psychological Healthcare, PLLC CurrentSince Oct 1, 2021 Accepting new patients
Schenectady Family Health Services, Inc. CurrentSince May 20, 2020 Accepting new patients

Locations

1199 Harris Ave
Tawas City, MI 48763
Phone (517) 362-7800

511 Griffin Rd
West Branch, MI 48661
Phone (989) 345-5540

8289 Loop Rd
Baldwinsville, NY 13027
Phone (315) 452-0300

1044 State St
Schenectady, NY 12307
Phone (518) 370-1441

3300 James St
Ste 100
Syracuse, NY 13206

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1459987200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631491200000",
    "number": "1457715310",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1044 STATE ST",
            "city": "SCHENECTADY",
            "state": "NY",
            "postal_code": "123071508",
            "telephone_number": "518-370-1441",
            "fax_number": "518-395-9431"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1044 STATE ST",
            "city": "SCHENECTADY",
            "state": "NY",
            "postal_code": "123071508",
            "telephone_number": "518-370-1441",
            "fax_number": "518-395-9431"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WHALEN",
        "first_name": "SHANE",
        "middle_name": "THOMAS",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-04-07",
        "last_updated": "2021-09-13",
        "certification_date": "2021-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "089173",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02995513",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Schenectady, NY

Sources for this page

Verify at the official NPI Registry.