Shannon Bruckner, LCSW, CAADC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

CSW006270 Issued in GA

Practice address

119 Sycamore Dr
Athens, GA 30606-3462

Phone

(864) 659-0543

NPI assigned

May 1, 2018

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

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

State licenses

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.

• Sondermind Provider Network LLC

  • Clinical Social Worker
  • Denver, CO
  • NPI 1760854442

  GA

  Medicare reassignment NPD
• Bruckner Counseling

  • Clinical Social Worker
  • Watkinsville, GA
  • NPI 1558243642
  NPD Authorized official

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

{
    "created_epoch": "1525132800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663545600000",
    "number": "1497243836",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "119 SYCAMORE DR",
            "city": "ATHENS",
            "state": "GA",
            "postal_code": "306063462",
            "telephone_number": "864-659-0543"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "119 SYCAMORE DR",
            "city": "ATHENS",
            "state": "GA",
            "postal_code": "306063462",
            "telephone_number": "864-659-0543"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRUCKNER",
        "first_name": "SHANNON",
        "name_prefix": "Ms.",
        "credential": "LCSW, CAADC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-05-01",
        "last_updated": "2022-09-19",
        "certification_date": "2022-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "GA",
            "license": "C0263",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "GA",
            "license": "CSW006270",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shannon Brown, LCSW
• Miranda Browne
• Melissa Brownell, RD, LD, CNSC
• Erica D Brownfield, MD, FACP
• Jennifer Browning
• Nancy Brudney
• John Brueshaber Jr., NP-C
• Michael Brugger, P.A.
• Harlan Jason Bruner, M.D.
• Lia P Bruner, MD

• Clinical Social Worker in Athens, GA
• Providers in Athens, GA by specialty
• Clinical Social Worker in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2022; 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.