Brenda Shores, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

12470 Issued in MN

Practice address

1821 University Ave W
Suite N 464
Saint Paul, MN 55104-2801

Phone

(651) 659-2900

Fax

(651) 645-7307

NPI assigned

Aug 20, 2008

Last updated

Aug 20, 2008By 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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MN

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

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.

• Mental Health Resources, Inc.

  • Community/Behavioral Health Agency
  • Minneapolis, MN
  • NPI 1821276049
  Medicare reassignment NPD
• Mental Health Resources, Inc.

  • Community/Behavioral Health Agency
  • Saint Paul, MN
  • NPI 1790909703
  NPD
• Mental Health Resources, Inc.

  • Community/Behavioral Health Agency
  • Saint Paul, MN
  • NPI 1811175037
  NPD
• Mental Health Resources, Inc.

  • Case Management Agency
  • Minneapolis, MN
  • NPI 1982882106
  NPD (past)

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

{
    "created_epoch": "1219190400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1219190400000",
    "number": "1619124716",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1821 UNIVERSITY AVE W",
            "address_2": "SUITE N 464",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551042801",
            "telephone_number": "651-659-2900",
            "fax_number": "651-645-7307"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1821 UNIVERSITY AVE W",
            "address_2": "SUITE N 464",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551042801",
            "telephone_number": "651-659-2900",
            "fax_number": "651-645-7307"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHORES",
        "first_name": "BRENDA",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-08-20",
        "last_updated": "2008-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "12470",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICSW",
            "identifier": "12470",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Barbara Jean Shock, MA, LMFT
• Terra Shockman, MD
• Adeline Sholar, RD, LD
• Sholom Home East Inc
• Shores Therapy, LLC
• Casi Marie Short, CRNA
• Shoshana Center for Reproductive Health Psychology, PLLC (Shoshana Center)
• Carol Jeanne Showalter, MD
• Jason Showers, LADC
• John Shrake

• Clinical Social Worker in Saint Paul, MN
• Providers in Saint Paul, MN by specialty
• Clinical Social Worker in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2008; 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.