Active NPI
Selby Shields Bourne, MSW, LICSW
- Clinical Social Worker
- Centerville, MA
National Provider Identifier
1609196237
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 119067
- Practice address
- 889 W Main St
Suite C.
Centerville, MA 02632-3067 - Phone
- (508) 771-2402
- NPI assigned
- Jun 5, 2010
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 119067 | MA | Primary |
Addresses
Primary practice location
889 W Main St
Suite C.
Centerville, MA 02632-3067
Mailing address
Coastal Wellness, LLC
105 Webster St. Suite 5
Hanover, MA 02339
Phone (508) 360-2811
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 119067 | MA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1275696000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1711497600000",
"number": "1609196237",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "COASTAL WELLNESS, LLC",
"address_2": "105 WEBSTER ST. SUITE 5",
"city": "HANOVER",
"state": "MA",
"postal_code": "02339",
"telephone_number": "508-360-2811"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "889 W MAIN ST",
"address_2": "SUITE C.",
"city": "CENTERVILLE",
"state": "MA",
"postal_code": "026323067",
"telephone_number": "508-771-2402"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOURNE",
"first_name": "SELBY",
"middle_name": "SHIELDS",
"name_prefix": "Mrs.",
"credential": "MSW, LICSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-06-05",
"last_updated": "2024-03-27",
"certification_date": "2024-03-25",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MA",
"license": "119067",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Centerville, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.