Active NPI
Shavon Fulcher, LCSW
- Clinical Social Worker
- Dorchester, MA
National Provider Identifier
1619370459
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 216396
- Practice address
- 1353 Dorchester Ave
Dorchester, MA 02122-2932 - Phone
- (617) 288-3230
- NPI assigned
- Oct 8, 2014
- 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 | 216396 | MA | Primary |
Addresses
Primary practice location
1353 Dorchester Ave
Dorchester, MA 02122-2932
Mailing address
800 West St
3118
Braintree, MA 02184-3852
Phone (617) 759-4187
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 216396 | MA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1412726400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1412726400000",
"number": "1619370459",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "800 WEST ST",
"address_2": "3118",
"city": "BRAINTREE",
"state": "MA",
"postal_code": "021843852",
"telephone_number": "617-759-4187"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1353 DORCHESTER AVE",
"city": "DORCHESTER",
"state": "MA",
"postal_code": "021222932",
"telephone_number": "617-288-3230"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FULCHER",
"first_name": "SHAVON",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-10-08",
"last_updated": "2014-10-08",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MA",
"license": "216396",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dorchester, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.