Shamara Gibson, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

SW12874 Issued in FL

Practice address

921 N Davis St
Building B, Suite 315
Jacksonville, FL 32209-6804

Phone

(904) 359-3857

Fax

(904) 359-2503

NPI assigned

Jul 29, 2015

Last updated

Jul 29, 2015By the provider in NPPES

Sex

Female

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

Enrolled in FL

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

Specialty

Clinical Social Worker

Education

Other, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Maras Lighthouse Counseling Center LLCGroup PAC ID 1759724206, 4 clinicians

Practice addresses (Care Compare)

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Mara's Lighthouse Counseling Center, LLC

  • Clinical Social Worker
  • Jacksonville, FL
  • NPI 1407478613
  Medicare reassignment Care Compare group NPD
• Mara's Lighthouse Counseling Center, LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Jacksonville, FL
  • NPI 1962974766
  NPD

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

{
    "created_epoch": "1438128000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1438128000000",
    "number": "1598140733",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "921 N DAVIS ST",
            "address_2": "BUILDING B, SUITE 315",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322096804",
            "telephone_number": "904-359-3857",
            "fax_number": "904-359-2503"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "921 N DAVIS ST",
            "address_2": "BUILDING B, SUITE 315",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322096804",
            "telephone_number": "904-359-3857",
            "fax_number": "904-359-2503"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GIBSON",
        "first_name": "SHAMARA",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-07-29",
        "last_updated": "2015-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "SW12874",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Fred Lloyd Gibson IV, DC
• Katherine Woody Gibson, MA,CCC-SLP
• Loren Gibson
• Mollie Gibson, QASP
• Neil William Carlton Gibson, MD
• Tammeza Gibson, PA
• Theresa V Gibson, PHARMD
• Wesley Jay Gibson, RD
• Angelica Gicalone, OT
• Jannie E Gichia, CNM, ARNP

• Clinical Social Worker in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Clinical Social Worker in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2015; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.