NPIMap

Organization Active NPI

Shine Therapy and Coaching LLC

  • Clinical Social Worker
  • Natick, MA
National Provider Identifier
1548028038
Registry record updated May 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
SHINE THERAPY AND COACHING LLC
Practice address
209 W Central St Ste 202
Natick, MA 01760-3716
Phone
(617) 784-4619
Fax
(617) 784-4619
NPI assigned
Mar 8, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 7, 2025

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

Authorized official

Name
Keavy SmithNPI 1013074541
Title
Owner
Phone
(617) 784-4619

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193400000X SINGLE SPECIALTY GROUP 1041C0700X Primary

Addresses

Primary practice location

209 W Central St Ste 202
Natick, MA 01760-3716

Mailing address

209 W Central St Ste 202
Natick, MA 01760-3716
Phone (617) 784-4619

Other names 1

  • Shine Therapy Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250507000421 MA Part B Supplier - Clinic/Group Practice 1254858996 Receives reassigned benefits from 2 practitioners
Practice locations: Natick, MA

National Provider Directory

National Provider Directory

Locations

209 W Central St
Ste 202
Natick, MA 01760
Phone (617) 784-4619

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1709856000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1746576000000",
    "number": "1548028038",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "209 W CENTRAL ST STE 202",
            "city": "NATICK",
            "state": "MA",
            "postal_code": "017603716",
            "telephone_number": "617-784-4619",
            "fax_number": "617-784-4619"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "209 W CENTRAL ST STE 202",
            "city": "NATICK",
            "state": "MA",
            "postal_code": "017603716",
            "telephone_number": "617-784-4619",
            "fax_number": "617-784-4619"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHINE THERAPY AND COACHING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-03-08",
        "last_updated": "2025-05-07",
        "certification_date": "2025-05-07",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "KEAVY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "617-784-4619"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shine Therapy",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Natick, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.