Reginald Harrison Shockley Sr., LCSW-C

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

24065 Issued in MD

Practice address

106 Milford St Ste 201
Salisbury, MD 21804

Phone

(410) 334-6961

Fax

(410) 334-6960

NPI assigned

Nov 8, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

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.

• Balanced Life Counseling Services, LLC

  • Clinical Social Worker
  • Salisbury, MD
  • NPI 1770084535
  NPD
• Eastern Shore Psychological Service

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Salisbury, MD
  • NPI 1548348402
  NPD (past)
• Eastern Shore Psychological Service, LLC

  • Community/Behavioral Health Agency
  • Princess Anne, MD
  • NPI 1730252537
  NPD (past)
• Safe Harbor Christian Counseling LLC

  • Clinical Social Worker
  • Bel Air, MD
  • NPI 1245377894
  NPD (past)

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

{
    "created_epoch": "1162944000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1532390400000",
    "number": "1619046919",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "34462 FOX HOUND CT",
            "city": "PARSONSBURG",
            "state": "MD",
            "postal_code": "218492676",
            "telephone_number": "443-614-5360",
            "fax_number": "410-334-6960"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "106 MILFORD ST STE 201",
            "city": "SALISBURY",
            "state": "MD",
            "postal_code": "21804",
            "telephone_number": "410-334-6961",
            "fax_number": "410-334-6960"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHOCKLEY",
        "first_name": "REGINALD",
        "middle_name": "HARRISON",
        "name_suffix": "Sr.",
        "credential": "LCSW-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-08",
        "last_updated": "2018-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MD",
            "license": "24065",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UHC MAMSI GROUP #",
            "identifier": "517251",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST BCBS GROUP",
            "identifier": "LM49EA",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST FEDERAL GROUP",
            "identifier": "R968",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "609550001",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAGELLAN GROUP",
            "identifier": "259147000",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Stephanie Marie Shipley, PTA
• Karen Roeseler Shipman, LCSW-C
• Mahmaud Shirazi, MD
• Megan Shockley, CRNP
• Meisha Shockley
• Shore Serenity Counseling & Wellness
• Shore Up Inc (Shady Pines Adult Day Services)
• Shore Up Inc.
• Shoreline Primary Care and Wellness
• Alyssa Lauren Shores, LCSW-C

• Clinical Social Worker in Salisbury, MD
• Providers in Salisbury, MD by specialty
• Clinical Social Worker in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2018; 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.