Shamia Keona McCallum

Primary specialty

Social WorkerTaxonomy code 104100000X

License

24991 Issued in MD

Practice address

1515 Martin Blvd Ste 206
Middle River, MD 21220-4103

Phone

(410) 971-0370

NPI assigned

Jul 31, 2019

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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.

• The Safe Space Therapeutic Services

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Middle River, MD
  • NPI 1568118438
  NPD Authorized official

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

{
    "created_epoch": "1564531200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649116800000",
    "number": "1518511237",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6218 KENWOOD AVE",
            "city": "ROSEDALE",
            "state": "MD",
            "postal_code": "212372021",
            "telephone_number": "410-971-0370",
            "fax_number": "410-971-0370"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1515 MARTIN BLVD STE 206",
            "city": "MIDDLE RIVER",
            "state": "MD",
            "postal_code": "212204103",
            "telephone_number": "410-971-0370"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCALLUM",
        "first_name": "SHAMIA",
        "middle_name": "KEONA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-07-31",
        "last_updated": "2022-04-05",
        "certification_date": "2022-04-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MD",
            "license": "24991",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38-3876389",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Charles B Marek Jr., MD
• Tiffany Elizabeth Mark
• Paul Martins
• Maryland CVS Pharmacy LLC
• Maggie Matassa
• Matthew David McCarty-Gibson
• Jemiera Marie McClary
• Jane McClean, ATC, LAT
• Victoria Symone McKenzie
• Kimberly Bradshaw McNulty

• Social Worker in Middle River, MD
• Providers in Middle River, MD by specialty
• Social Worker in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2022; 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.