Individual provider Active NPI

Shawn Trifoso, LCSW

  • Clinical Social Worker
  • Syracuse, NY
National Provider Identifier
1619410073
Registry record updated Aug 13, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
091447 Issued in NY
Practice address
742 James St
Syracuse, NY 13203-2017
Phone
(315) 703-2700
NPI assigned
Dec 2, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 13, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 091447 NY Primary

Addresses

Primary practice location

742 James St
Syracuse, NY 13203-2017

Mailing address

742 James St
Syracuse, NY 13203-2017
Phone (315) 703-2700

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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

Enrollment IDStateProvider typePAC IDDetails
I20221129000568 NC Practitioner - Clinical Social Worker 7719383272 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
University Psychological Associates PAGroup PAC ID 9335187442, 12 clinicians

Practice addresses (Care Compare)

10001 Old Concord Rd
Charlotte, NC 28213-3646
Phone (704) 547-1483

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
University Psychological Associates, P.a. CurrentSince Nov 14, 2022 Accepting new patients

Locations

726 East Blvd
Charlotte, NC 28203
Phone (704) 376-8494

10001 Old Concord Rd
Charlotte, NC 28213
Phone (704) 547-1483

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1480636800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1628812800000",
    "number": "1619410073",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "742 JAMES ST",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132032017",
            "telephone_number": "315-703-2700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "742 JAMES ST",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132032017",
            "telephone_number": "315-703-2700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TRIFOSO",
        "first_name": "SHAWN",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-12-02",
        "last_updated": "2021-08-13",
        "certification_date": "2021-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "091447",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Syracuse, NY

Sources for this page

Verify at the official NPI Registry.